FAIS African Female Database Form

FAIS African Female Database Form
Name*

First NameLast Name
Email*
example@example.com
Institute*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Career stage*

Undergraduate StudentPhD StudentPost-doctoral ResearcherResearch Assistant/TechnicianNew FacultyTenured FacultyIndustryGovernment/PolicyOther (please specify)
Website (if any)
ORCID Number (if any)
Area of research*

Allergy and AsthmaAutoimmunityCancerDiseases -Infectious Diseases - AllInfectious Diseases - Viral DiseasesInfectious Diseases - Bacterial DiseasesInfectious Diseases - Parasitic DiseasesInfectious Diseases - Fungal Diseases
Immunology field of Research*

Innate ImmunityAdaptive ImmunityMucosal ImmunologyVaccines and ImmunotherapeuticsAllergy and Autoimmune DiseasesTumor Immunology and Anti-tumor ImmunotherapyImmunodeficiencyTransplantationNeuroimmunologyImmune Regulation and Immune SuppressionHost-Pathogen Interactions and immunogeneticsVeterinary and Comparative ImmunologyNew Technologies in ImmunologySignal transductionCytokines and their receptorsAntibodiesB CellsT CellsDendritic CellsNatural Killer CellsInnate Lymphoid CellsMastCells/Basophils/EosinophilsMonocytes/MacrophagesNeutrophilsNKT Cells
Profile/Biography (ca. 100 - 200 words)
Picture

Cancelof
Professional links (ORCID, research gate, googlescholar, LinkedIN etc...)
Keywords (Add as appropriate)
I hereby consent to the processing of the data that I have provided and declare my agreement for this data to be included in the FAIS African Female Database, on the FAIS Website. I understand I may request for my data to be removed at any time by contacting FAIS at: info@faisafrica.com*

Yes
Should be Empty: