CANCER SCIENCE INSTITUTE OF SINGAPORE

MEMBERSHIP APPLICATION FORM



1. APPLICANT'S DETAILS (blue fields are required)
Name:





Last Name

First Name

Middle Name
Title: (?)

Position: (?)

Department/Division:

Organization:

Mailing Address:

Phone (Office): (?)

Mobile: (?)

Email:

2. FIELD OF RESEARCH OR HEALTHCARE PROFESSION

Please provide brief description of your cancer research interests.

Please provide a few keywords that describe your cancer research interests and indicate the CSI Program and Disease Group you are interested in. (not exceeding 40 words)
(see website:https://www.csi.nus.edu.sg/ws/research/research-programs
and disease group https://www.csi.nus.edu.sg/ws/research/disease-groups)

Please list your active collaboration with CSI Investigators (if any)
Please indicate which type of membership you are applying for: (select one)
Principal Associate

Associate

Distinguished Member


3. SUBMISSION INFORMATION
PLEASE INCLUDE THE MOST CURRENT COPY OF YOUR BIOSKETCH AND SAVE IT AS (YOURNAME_BIOSKETCH) (Download Template Here).


All applications will be reviewed by the CSI Membership Committee. Successful applicants will be informed through a formal letter of appointment after the review.

For all membership enquiries, please contact CSI Membership Coordinator at Tel: +65 65167287 or email: csi_singapore@nus.edu.sg

4. MEMBERSHIP AGREEMENT AND SUBMISSION
I hereby confirm that the information contained in this application is correct and I agree to the Membership Responsibilities. By submitting this form, I consent to National University of Singapore (NUS) collecting, using and/or disclosing my personal data to third parties (including any third party located outside of Singapore) for the purpose of processing the application, advertising and communication, assisting enquiries, and conducting research and surveys, stated herein.