Faculty Membership Application Form
This form is for faculty at Washington University to apply to join as members of the Center of Regenerative Medicine. CRM website: https://regenerativemedicine.wustl.edu/ 
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Email *
Name (First Last)? *
Degrees(s)
Academic Title
Primary department and/or division
Secondary appointments
Social media handle (e.g. X/twitter)
Office location
Campus box #
Administrative Assistant (if relevant)
Briefly describe your research interests. Include a one-­‐two sentence general description that will be used on the Center of Regenerative Medicine Website.
Describe how your research and career would benefit from being a member of the CRM
In which of the following areas does your research fit (choose all that apply)?
Please email us at crminfo@email.wustl.edu to let us know that you have completed this form (just a simple "Membership form submitted!" in the subject is fine)
A copy of your responses will be emailed to the address you provided.
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