Centre for Neuroscience
Researching the nervous system in health and disease
MEMBERSHIP FORM FOR 2016
Applicant’s Details
Title: please select one
E. Prof
/
Prof
/
Assoc Prof
/
Dr
/
Mrs
/
Ms
/
Mr
Name:
Email Address:
Position:
CNS Laboratory:
(If applicable)
Department:
Organization:
Membership Details
Please select one ( √ )
New Member
All staff of Flinders University, and staff of affiliated institutions with
Academic Status at Flinders University, carrying out research in the
neurosciences or related clinical disciplines
Full
Category of
Membership:
Renewing Member
Associate
Retired Staff; Researchers in the neurosciences or related clinical
disciplines at other Institutions
Please select one
Student
Undergraduate or postgraduate students at Flinders University, with
an interest in the neurosciences
Activity / Participation Details
Which CNS activity in 2016
would you like to register for:
At least one activity must be
chosen. All can be selected
except where noted.
Attend NeuroSeminars
Attend NeuroLunches
Present a NeuroSeminar
Present a NeuroLunch
Mark a CNS Student Seminar (not available to CNS Student Members)
Please complete this form and return to the CNS Secretary, via one of the methods below.
Full and Student
Members
Associate Members
Deliver in person to room 6E:121, Level 6,
Flinders Medical Centre
Post to: Attn: K MacDonald
Centre for Neuroscience
Flinders University
GPO Box 2100
ADELAIDE SA 5001
OR Email:
Enquiries: cns@flinders.edu.au
cns@flinders.edu.au
Phone: +61 8 8204 5271
www.flinders.edu.au/neuroscience/