Standard Membership – International Neurotrauma Society

Name:*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Institution:* Institution is Required

Highest degree awarded: Highest degree awarded is not valid

Year highest degree awarded: Year highest degree awarded is not valid

Status:* Status is Required

Career Stage: Career Stage is not valid

Area of interest:* Area of interest is Required

Have attended a recent INTS Symposium:* Have attended a recent INTS Symposium is Required

Yes No

Year Attending: Year Attending is not valid

Upload curriculum vitae listing relevant training and/or publications in English: Upload curriculum vitae listing relevant training and/or publications in English is not valid

Upload Letter of Support from Supervisor (Trainees) or Head of Department (All others).: Upload Letter of Support from Supervisor (Trainees) or Head of Department (All others). is not valid

Gender: Gender is not valid

Age range: Age range is not valid

Racial/Ethic Group Identification: Racial/Ethic Group Identification is not valid

Do not include my information on the membership directory:* Do not include my information on the membership directory is Required

Yes No

Email:* Invalid Email

No val Please fix the errors above

Pay International Neurotrauma Society

$25 for access until December 31, 2024

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	Standard Membership – Payment $25 for access until December 31, 2024	$25.00
	Total	$25.00

Standard Membership – Payment

$25 for access until December 31, 2024

$25.00

Total

$25.00