Membership

Would you like to become a member of the QNJPI?  Please fill in the following form:

First Name

Last Name

Title

Other (if no title applies)

Email

Phone number (Work)

Phone number (Mobile)

What degree are you currently pursuing?

Other (if no degree applies)

What is your principal university affiliation?

Which FRQ-S research centre are you affiliated to?

Who is your director/supervisor?

If applicable, who is your co-director/supervisor?

What type of research are you currently pursuing?
ClinicalBasicHealth population

Are you a member of another FRQ-S thematic network?

Which general discipline better represents your expertise on pain research?

Other (if no discipline applies)

From the list below, what is your PRINCIPAL pain research interest?

Other (if no discipline applies)

From the list below, what is your SECONDARY pain research interest?

Other (if no discipline applies)

By checking this box, I agree that the information given in this form can be used for statistical and networking purposes.
I agree

Do you accept to receive Email from the QNJPI?
YesNo

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