Application form

Last name First name

Work address

City Province Zip Code

Email Work phone

Employer and academic position(s)

Indicate how much time you spend on:

Indicate 0% in the categories that would not apply to you.

Clinical Practice

Teaching

Research

Administration

Other, please specify:

Biography

(French or English) Please note that your biography and professional contact information will be published on the IMS website

Documents to be attached to the application form:

Description of your research program - 1 page maximum, time new roman 12pt (word or pdf format).
CV in word or pdf format (CCV if available)

Candidate Acknowledgements

I have read the IMS policies and procedures and the requirements for membership categories - (http://1334-ism-old.demo.tonikwebstudio.com/recherche/joindre-ism/ )