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Institute for Engineering in Medicine (IEM)
Application for Membership
Part I: Demographic Information
Name
Phone
Degree
Email
Department/Company
Current Position
Mailing Address
Office Address
Part II: Resume
Please submit the following: Updated NIH biographical sketch
Part III:
Current Research Interests in Engineering in Medicine
Please provide a brief narrative paragraph outlining your interests in engineering in medicine and/or related
activities. Please include biomedical interest as well as engineering approaches of your activities.
Part IV:
Research Interest: (Please check all that apply.)
Cardiovascular Engineering
Cellular and Molecular Bioengineering
Medical and Biological Imaging
Medical Devices
Neuroengineering
Other
Part V:
Disease/Application Area (Please check all that apply.)
Cancer
Cardiovascular / Pulmonary Systems
Gastroenterology
Hematology / Hematopoiesis
Mental Health
Metabolism
Neurological Systems
Ophthalmology
Orthopaedics
Public Affairs
Urology
Other
** Please email this application and your NIH Biosketch to the Institute for Engineering in Medicine at
[email protected]
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