Trainee Membership Application

Trainee Membership Application

Submit this application to

Name: Click here to enter name.

Academic Degree: Click here to enter academic degree.

PENN Rank/Title: Click here to enter PENN rank/title.

Department(s): Click here to enter department(s).

Other Appointments: Click here to enter other appointments.

Address: Click here to enter address.

Phone: Click here to enter phone.

Email: Click here to enter email address.

Website URL (to link to name on CTER website): Click here to enter website URL.

If you are an MD or PhD postdoc, please provide the name of your primary faculty mentor: Click here to enter your primary faculty mentor.

If you are currently in a formal degree-granting program (e.g., MSCE, MSPH, MBE) please provide the name of the program: Click here to enter the name of the program.

Research Interests (check all that apply):

☐ Methods for performing clinical effectiveness trials

☐ Adherence

☐ Personalized medicine (pharmacogenetics)

☐ Implementation strategies

☐ Other: Click here to enter text.

Please use one paragraph to describe your background and current research interests as they relate to CTER objectives. This will be posted on the CTER website.

Click here to enter text.

922 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 Phone: 215-898-1740 Fax: 215-573-3106