Brain Health Care (BHCare) Training Program – BHCare Co-Investigator Registration Form

Name *

First

Last

Email Address *

Please indicate your affiliated institution or organization. *

Please indicate your position or role. *

Please select the working group(s) you are interested in joining: *

Are you willing to serve as a reviewer for the stipend/award peer review process? *

Are you interested in hosting or presenting a webinar for BHCare? *

If yes, please indicate the webinar topic(s) you are interested in hosting/presenting: *

Are you willing to be a mentor for the BHCare training platform? *

If yes, please indicate the type of trainees you are interested in mentoring (e.g., undergraduate, master’s, PhD, postdoc): *

Please provide keywords of your expertise and areas of interest: *

6) Please include me in the following mailing lists *

BHCare Co-Investigator Registration Form