Membership Application
|
|
First Name |
Last Name |
|
|
|
|
|
|
Degree |
|
|
|
|
|
|
|
College |
Department |
|
|
|
|
|
|
Mailpoint |
Email |
|
|
|
|
|
|
Phone |
Fax |
|
|
|
|
|
|
|
My research is in one or more of the following BITT research areas (check all that apply) |
|
Drug Discovery |
|
Diagnostics |
|
Identification |
|
Targeted Therapeutics |
|
|
Active collaborations with the following faculty |
|
|
|
|
Current membership in one of the following USF Centers: |
|
Center for Molecular Discovery in Drug Design and Development (CMD5) |
|
Center for Molecular Delivery |
|
Advanced Biosensors Laboratory |
|
|
Brief summary of your research including the multidisciplinary aspects of it (50-100 words) |
|
|
|
|
I agree to participate in one or more of the following ways: |
|
willing to give seminars |
|
willing to participate in a retreat |
|
willing to take a student |
|
|
As a member of the center I agree to do one or more of the following: |
|
Attend conferences |
|
Present at retreat(s) or seminar(s) |
|
Serve on a committee |
|
|
IMPORTANT: Please email an NIH-style Biosketch or a Curriculum Vitae to bitt@bitt.usf.edu when you submit your application. |
|
|
For verification purposes, please type BITT into the box below before submitting the form. |
|
|
|
|
|