First Name (Required)

Last Name (Required)

Email (Required)

Position (Required) (e.g. PhD student, Postdoc, PI, Professor, Private sector employee, Freelance, etc.)

Affiliation / Department (Required)

Country (Required)

Briefly describe your research or commercial interest(s) (Required)

Briefly describe how you believe you can contribute to and/or benefit from the BioBrillouin community (Required) (General goals of the BioBrillouin network can be found in the MoU )

Representative publications (up to 4)

Studies / Educational background (please be as general as possible to avoid too many categories) (Required) Examples: Biology, Physics, Chemistry, Mathematics, Engineering, etc.

Other comments

You may upload a photo which may be used in an Annex Directory of attendees during meetings. We will explicitly ask for your permission prior to using. Max. file size 10Mb / Allowed file types: .jpg, .png

The following will be used for generating reporting statistics only.

Year you were awarded or expect to be awarded PhD (if applicable)

Gender

• Female
• Male
• Other

I confirm I have read the Privacy Policy (Required)

I agree and consent to the procedure that, if accepted, my name, affiliation and country are published on public BioBrillouin member lists. The information I provide may further be used for (non-public) network purposes within BioBrillouin. (Required)

Website *