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MEMBER INFORMATION

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Contact info@gadacanada.ca if you need assistance

First Name (*)

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Degree(s)

Sex FemaleMale

Year of Birth

APPLICATION GUIDELINES:
Please fill out the application form and attach your current CV for approval by the MAC steering comittee. You will receive an e-mail from the MAC admin office informing you of the status of your membership application within 7-10 days. Please upload your CV here:

I have uploaded my current CV.*


ADDRESS

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US ONLY

State

ZIP

NON-US ONLY

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I DO NOT wish to receive commercial mailings.

DEMOGRAPHIC INFORMATION

Completion of this section is optional. However, your responses will help the MAC Board plan future activities and better represent members’ interests. Even if you have previously answered these questions, we ask that you take a moment to provide your current information.

PRIMARY AFFILIATION (Select one)

GeneticsPathologyMedicineRepro. Medicine

Family MedicinePediatricsPsychiatry/PsychologyOB/GynNeurologyInternal Medicine

Hospitals and ClinicsDental SchoolsCollege/UniversityVetinary SchoolCommercial CompanyFederal GovernmentRetiredOptometry

HMOPublic Health / Grad SchoolNursing SchoolPrivate PracticeInstitutes / FoundationsState / Local GovernmentConsultantOther


EARNED DEGREES (Select up to four)

MDPhDMSWDVMSCD

DDS or DMDEDDMSMAMSN

JDMPHRNBSNBS or BA

DOODMD/PhDOTHER


ACADEMIC RANK (Select one)

ProfessorAssociate ProfessorAssistant Professor InstructorNonfaculty


POSITION (Select up to two)

DeanDepartment ChairDivision ChiefInstitute Center DirectorLaboratory DirectorTraining Program Director

Research Program DirectorProgram Coordinator/AdministratorSenior Research AssociateResearch AssociateResearch AssistantGenetic Counselor

Postdoctoral Research FellowPostdoctoral Clinical FellowResidentGraduate StudentPrivate PracticeCorporate Executive

ConsultantPrincipal Investigator/ProfessorUndergraduateOther


MAJOR TYPE OF WORK (Select one that accounts for more than 50% of your time)

ResearchTeachingAdministrationClinicalCounseling


SECONDARY TYPE OF WORK (Select one if it represents a significant portion of your time and is different to your major type of work)

ResearchTeachingAdminisrationClinicalCounseling


LABORATORY SETTING (If you are primarily in a laboratory setting, indicate focus)

Private diagnostic/reference labPrivate research labUniv-affiliated diagnostic/reference labUniv-affiliated research labGovernment-affiliated research lab


SPECIAL INTEREST AREAS (Select up to four)

Cancer GeneticsCytogeneticsDNA forensicsDifferentiation & developmentDysmorphologyEthics/social/legal/policy issues

Gene structure & functionInborn errors/biochemical geneticsLate onset/adult genetic disordersLinkage mapping & polymorphismsMolecular geneticsPediatric genetics

Physical mappingPopulation genetics/epidemiologyPrenatal/perinatal geneticsGenomicsModel systemsInformatics

Neurogenetics/behavioral geneticsPublic health geneticsEducationPolicy/AdvocacyEvolution


CURRENT GRANT SUPPORT (Select all that apply - US and Canadian members only)

NSF (NSERC in Canada)NIH (CIHR) training grantPrivate IndustryNIH (CIHR in Canada)

Postdoc fellowshipPrivate foundation/charityStateProvince

InstitutionalOther national agenciesHHMIMRC

Wellcome


DESIGNATION(S) FOR YOUR RESEARCH (Select all that apply)

Applied clinical researchApplied lab researchApplied mathematical researchBasic clinical research

Basic lab researchBasic mathematical researchELSI/eduation/policyOther

DONATIONS

A DONATION TO MAC MAKES A DIFFERENCE
MAC is administered by GADA Canada, a nonprofit organization, therefore, contributions are tax deductible to the extent permitted by law. Please click here to donate to MAC.


Please review this form for completeness and accuracy before submitting it.