July 8 - July 10, 2002
Along with the submission of this application, the following items are required for an application to be considered:
First Name: Middle Name: Last Name:
Degree: Job Title/Position:
Employment Address:
Mailing Address (if other than above):
Daytime Telephone: Fax Number: (Please include country & city code for International Calls)
E-mail address: Please indicate whether you would object to having your email address be published in our directory: Yes No C. References: List two people who will supply letters of recommendation:
Summer Workshop in fMRI Informatics The fMRI Data Center Dartmouth College 6162 Moore Hall Hanover, NH 03755 USA http://www.fmridc.org email: summerworkshop@www.fmridc.org