IPEG
International Pharmaco-EEG Society
Association for Electrophysiological Brain Research
in Preclinical and Clinical Pharmacology and Related Fields
Family name/First name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Title(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Affiliation/current position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Tel./Fax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
E-mail address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would like to apply or active membership* / junior membership**
*Active membership requires a CV, a list of publications and maximally two reprints of publications about pharmaco-EEG, -ERP, other aspects of electrophysiology in preclinical and clinical research and/or related fields.
**Junior membership (students or other persons below the age of 30 years) requires only a CV.
Enclosed you will find:
CV yes/no
list of publications yes/no # of reprints:
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(Date)
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(Signature)
Please send application form (with enclosures) to: