Student Information

In preparing for the course, it helps us to know a little about your background and interests. In the fields below please tell us about your background (academic, clinical, research, industrial, or other), and experience with functional neuroimaging. This is also an opportunity to state what you most hope to learn about during the course.

Your information will be shared with the faculty and other students in the course.

Name and Contact Information

Given Name: *

Family Name: *

Degree:

Department:

Institution:

Address 1: *

Address 2:

City: *

State: *

Postal or Zip Code: *

Country: *

Email: *

Office Phone:

Mobile Phone:

Which course are you planning to attend?: *

SPM8 for Basic and Clinical Investigators - Boston JUN2010

SPM8 for Basic and Clinical Investigators - Boston OCT2010

Network Analysis - Boston OCT2010

SPM8 Chicago - Chicago NOV2010

SPM8 for Basic and Clinical Investigators - Pittsburgh JAN2011

Background Information

Educational Background: *

Please describe your educational background, particularly with respect to coursework in experimental design, statistics, and signal processing.

Years of fMRI Experience: *

Work Environment: *

Please describe your current work environment including imaging facilities.

Research Interests: *

What psychological or physiological domains are of most interest to you?

Educational Goals: *

What are your goals in attending the course? Are there particular topics you want to hear about?

Your Photograph:

Please send us your photograph, so we can recognize you at the course..

Questions:

Do you have any questions about the course?

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Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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