Functional MRI Visiting Fellowship: Registration Form

NOTE: Please fill out brief "Biosketch" and optional photo, at the bottom of this page.

Preferred Date

Course Fees

The fee for the program is $1500. A reduced rate of $1000 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.

We need to receive your tuition payment 4 weeks prior to the course to guarantee your registration. Please contact us should special arrangements need to be made regarding payment. Course fees are refundable up to 30 days prior to the session. A $200 fee will be deducted, should you request a refund up to 2 weeks prior to the program. After that, the tuition can be applied to a future program. MD's PhD's and post docs do not qualify 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 be sure the NAME OF PARTICIPANT is included with the check.

Biosketch

Please include an informal statement describing your background (academic, clinical, research, industrial, other), your experience with MR imaging, and your experience with functional neuroimaging. This is also an opportunity to state what you most hope to get out of the program.

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.