MHF Centre for Brain Cancer Research - Membership Registration Form

Register to become a member of the MHF Centre for Brain Cancer Research

Becoming a member of the MHF Centre for Brain Cancer Research will help you to: discover other researchers, clinicians and consumers across Australia who can engage with your research and help progress your ideas. Our aim in providing a national network is to: provide a collaborative forum for research that improves brain cancer outcomes and service delivery, offer the latest news happening in the field, and provide access to funding opportunities as they arise.
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please choose the description(s) that best fit you:*

ResearcherHealth ProfessionalStaff member of a support servicePerson affected by Brain Cancer (e.g. current or past patient, family member, carer)Please tick here if you or a loved one have been affected by brain cancer and wish to join our Consumer Registry to engage with other consumers and researchersOther
Professional Details - Company Name & Department*
Professional Details - Job Title*
Primary Employer*

Tertiary InstitutionLocal Health DistrictResearch InstituteOther
If other, please advise:
Do you participate in any activities with the following organisations?*

Tertiary InstitutionLocal Health DistrictNSW Regional Cancer Research NetworkHNECC PHNHunter Cancer HubSydney Cancer PartnersSPHEREABCARACOGNOABTCRUN DIPGANZCHOGNot Applicable
Please indicate your research career stage:*

Early Career Researcher (1-5 years Post PhD)Mid-Career Researcher (5-10 years Post PhD)Senior Researcher (over 10 years PhD)Not Applicable
Membership Endorsement: Your application is required to be endorsed by one stream leader. Please select all streams from below that are relevant to your application. These leaders will be notified of your application, will be asked to accept or decline your request and we will notify you of the outcome as soon as possible.
New Member Endorser (please select all that apply):*

Patient Experience - Professor Michael FayExperimental Therapeutics - A/Professor Paul TooneyTranslational Neuroscience - Professor Hubert HondermarckBrain Cancer Imaging - A/Professor Saad RamadanBlood-Based Biomarkers - Doctor Richard LobbPaediatric Brain Cancer - Professor Matt Dun
Our Privacy Policy: by submitting the form, you accept
- your name and email address will be provided to your endorser(s)
- this is an application only and membership status remains pending until reviewed, endorsed and approved.
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Register to become a member of the MHF Centre for Brain Cancer Research