NHLBI Progenitor Cell Biology Consortium (PCBC)



Human Induced Pluripotent Stem Cells and Their Differentiation

into Endoderm and Lung-Progeny Course

The Center for Regenerative Medicine (CReM)

Boston University Medical Center

Boston, MA

April 9, 2018 – April 13, 2018

Application Form

Name: ___________________________ ______ ___________________________________

First Middle Initial Last

Yes No

Degrees: Ph.D. ( ) ( )

M.D. ( ) ( )

Other ( ) ( )

Address: _________________________________________________________________________

Street 1

_________________________________________________________________________

Street 2

_________________________________________________________________________

City State Zip Code

Telephone Number (Voice): ______________________________________________

FAX Number: _________________________________________________________

Email Address: ________________________________________________________

PCTC Research Hub: ____________________________________________________________________ubHHHNfkdfdj

Research Hub (U01) Principal Investigator: ___________________________________________________

U.S. Residency Status: ( Citizen; ( Permanent Resident or Applicant; ( Student VISA; ( Work VISA; ( Teacher/Researcher VISA; ( Other.

Yes No

Will Lodge at the Hampton Inn and Suite, Boston Crosstown Center: ( ) ( )

PCTC Research Project Title: _____________________________________________________________

Basic Cell Culture Technical Experience: Yes No

( ) ( )

Describe: ______________________________________________________________________________

______________________________________________________________________________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download