Functional MRI Visiting Fellowship: Registration Form

Preferred Date

Course Fees

The fee for the program is $1200. A reduced rate of $700 is available to graduate students with a letter of verification from their Department Chairman. Course fees are refundable up to 30 days prior to the session. MD's PhD's and post docs do not quality for the graduate student rate.

Make checks payable to: fMRI Visiting Fellowship Program

Mail checks to:

Stacey Ladieu
Athinoula A. Martinos Center for Biomedical Imaging
149 Thirteenth Street - Room 2301
Charlestown, MA 02129

Please include YOUR NAME on the check.

Biosketch

Please include an informal statement describing your background (clinical, research, industrial, other), your experience with MR imaging, and your experience with functional neuroimaging. This biosketch will be distributed to the faculty and to other course participants. It should be no more than two paragraphs in length.

PLEASE: Make the biosketch informal. It is intended to introduce you to the other participants and staff, not to apply for a job

We like to send out these biosketches to faculty, staff, and course participants, and it would be nice to be able to include a photograph. So, if you would be willing to, please select your photo here (in .jpg format). Otherwise, you will have the option to upload a photograph after you have been accepted into the course.