61778 55th Annual MSBRF - Judge Availability Survey

CONTACT INFORMATION

This survey is intended to gauge your availability for judging of the 55th Annual Midwest Student Biomedical Research Forum.

Abstracts judging will begin in January 2024.

The Forum will be held IN PERSON at the Mike and Josie Harper Center for Student Life and Learning on Saturday, March 2, 2024.

Contact Information

Question Title

* Full Name
(Please list your name and credentials exactly as you want them to appear on all promotional materials.)

First Name / Middle Initial
(if applicable)

Last Name

Credentials

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* Cell Number: (Please include the area code)

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* Email Address:

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* Affiliation: (Indicate all that apply.)

Creighton University

University of Nebraska Medical Center

Veterans Administration Medical Center

Other (please specify)

61778 55th Annual MSBRF - Judge Availability Survey

CONTACT INFORMATION

Question Title

* Full Name
(Please list your name and credentials exactly as you want them to appear on all promotional materials.)

Question Title

* Cell Number: (Please include the area code)

Question Title

* Email Address:

Question Title

* Affiliation: (Indicate all that apply.)

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* Department Name

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* Department Phone (Please include the area code)

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* Campus / Zip Code

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* Please provide a brief description of your personal research interests:

Question Title

* Full Name(Please list your name and credentials exactly as you want them to appear on all promotional materials.)

Question Title

* Cell Number: (Please include the area code)

Question Title

* Email Address:

Question Title

* Affiliation: (Indicate all that apply.)

Question Title

* Department Name

Question Title

* Department Phone (Please include the area code)

Question Title

* Campus / Zip Code

Question Title

* Please provide a brief description of your personal research interests:

* Full Name
(Please list your name and credentials exactly as you want them to appear on all promotional materials.)