Center for Biomedical Informatics Membership Application

The Center for Biomedical Informatics was established at Wake Forest to strengthen the institution's research, education, and clinical missions and is directed by Dr. Metin Gurcan, Professor of Internal Medicine. This cross-disciplinary initiative is designed to integrate resources at the Wake Forest School of Medicine, Wake Forest Baptist Medical Center, and Wake Forest University and complement the work of other research centers, including the Wake Forest Clinical and Translational Science Institute.

Please complete the information below to request membership with the Center for Biomedical Informatics (WFBMI).

For questions, please contact the Center for Biomedical Informatics at WFBMI@wakehealth.edu

Last Name

* must provide value

First Name

* must provide value

Institution Affiliation:
(Wake Forest faculty indicate primary department of appointment)

* must provide value

Institution/Organization

* must provide value

Department

* must provide value

If 'Other,' please specify:

Rank

* must provide value

If 'Other,' please specify:

What is your geographic affiliation?

* must provide value

Greater Charlotte NC Region

Greater Winston Salem NC Region

Greater Macon GA Region

Greater Rome GA Region

reset

Please select the type of membership that best suits your interests in participating in the Center for Biomedical Informatics.

Full/Core Member: Faculty who are primarily responsible for achieving the center's mission and goals.

Associate Member: Internal faculty members and staff who support and assist the center's research and other activities.

External Member: Those collaborators from outside the institution.

Student/Trainee Member. These include post docs, residents, graduate and medical students.

* must provide value

Briefly describe your research interests and why you would like to join the Center for Biomedical Informatics.

Expand

Please upload a current biosketch (NIH format) or CV including other support.

* must provide value

Upload file

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.