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Membership Application 2009 - 2010 Academic Year Consortium of Academic Programs in Clinical Research Academic Institution: ____________________________________________________ Program Name: _________________________________________________________ College Name: __________________________________________________________ Department Name: ______________________________________________________ Mailing Address: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ Program Director/Coordinator _____________________________________________ Phone Number: _________________________________________________________ Email ______________________________________________________________ Indicate what degree(s) or certificate(s) your program offers:o Doctorateo Masterso Postbaccalaureate Certificateo Baccalaureateo Associateo Prebaccalaureate Certificateo Other (including continuing education offering or workshop), specify _____________________
Mail your completed application and your institutional membership fee of $100 to: Stephen A. Sonstein, Secretary/Treasurer c/o Consortium of Academic Programs in Clinical Research School of Health Sciences Eastern Michigan University 318 Marshall Building Ypsilanti, Michigan 48197 |
Membership Application 