Membership Registration

Application Information Form
    1. Pharmaceutical Firm
      Government
      University
      Others (Please identify)
    2. Basic Research
      Clinical Research
    1. Yes
      No
    2. Yes
      No
    3. Yes
      No
    1. Name
    2. Academic Background (list schools, dates, and degrees)
    3. Professional Experience
    4. Professional Society Memberships
    5. Government and other research support. Be specific and complete regarding amount, duration, project title, and name of Principal Investigator
    6. Your published scientific reports in refereed journals. When listing the published scientific reports, the applicant needs to insure that in all of the material cited the order of authorship is the same as in the published material.
    7. Your published scientific books and other published scientific abstracts, letters, book reviews, etc.