Course Registration

REGISTRATION INFORMATION

Given Name: *

Family Name: *

Degree: *

Department: *

Institution: *

Address 1: *

Address 2:

City: *

State: *

Postal or Zip Code: *

Country: *

Email: *

Contact Telephone: *

Which course are you planning to attend?: *

2012JAN SPM8 for PET and SPECT - New Haven

2012APR Network Analysis: Functional Connectivity - Pittsburgh

2012MAY12 SPM8 for Basic and Clinical Investigators - Melbourne

2012MAY21 Network Analysis: Functional Connectivity - Melbourne

2012JUN04 SPM and Functional Connectivity - Beijing

Registration type: *

Regular

Post-doctoral fellow

Student

Affiliation: *

Macquarie University investigator

CNBC investigator

Swinburne University investigator

Other

Payment type: *

PAYPAL

Cash

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The full workshop fee is $1500. Reduced rates of $1250 for post-doctoral fellows and $1000 for undergraduate, graduate or medical students are available. An additional 20% discount on these rates is available to all Swinburne University investigators. We must receive your tuition payment 3 weeks prior to the course to guarantee your registration. Please contact us should special arrangements need to be made regarding payment. Course fees are refundable up to 14 days prior to the session.
Onsite registration will NOT be available.
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To pay using PAYPAL, follow the instructions on the workshop website.
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Payment can also be made in CASH in $USD at the time of the course. Please email spmbasics@neurometrika.org if you wish to utilize this option.

Biosketch 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.

Educational Background: *

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

Years of neuroimaging 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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