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NC NM4R TES Workshop Registration

Thank you for your interest in the NC NM4R Workshop, "Current Topics in Transcranial Electrical Stimulation," to be presented both in-person on the campus of Medical University of South Carolina and remotely via Zoom on June 1 and 2, 2022.

To register for attendance, please provide us with some further information about yourself.

Registration is a two-part process in order to protect your privacy by sending as little data to Zoom as possible. This also enhances privacy and security by greatly reducing the chance of unwanted attendees.

First, please complete our secure registration form below. Upon submission of this form, your browser will be redirected to Zoom.us to complete the second step. Give Zoom your name and email address to receive your personalized link to the workshop.

Please do not share your personal Zoom link with anyone, but please do feel free to share this registration form!

If you have trouble with registration, do not receive an email confirmation with your personalized Zoom link, or have other concerns, please email Chris Schachte, schachtc@musc.edu.

First Name

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Last Name

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Please tell us the academic credentials/degrees you have attained (e.g., M.D., Ph.D., PT, OT, etc.).

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Please tell us the academic ranks/titles you have attained (e.g., Assistant Professor, Investigator, Lead Lab Technologist, etc.).

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Please list your current institutional and departmental affiliation(s).

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Please select the state in which the primary institution with which you are affiliated is located.

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Please give us two or three sentences explaining your interest in the workshop.

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Do you plan to attend remotely via Zoom or in person on the campus of Medical University of SC in Charleston, SC?

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Zoom

In person

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Breakfast and lunch are provided for workshop attendees. Do you have any food allergies, dietary restrictions, or other needed accommodations?

Do you have any practical experience with electrical field modeling and/or electrode optimization toolboxes?

It would be beneficial to your e-field modeling hands-on experience if you are able to bring a computer with Matlab installed.

Yes

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A brief CV or biosketch is required for workshop registration.

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What is your gender identity?

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Female

Male

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Prefer to self-describe...

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Please feel free to give us more information about your gender identity.

Are you Hispanic or Latino?

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Yes

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What is your race?

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American Indian/Alaska Native

Asian

Native Hawaiian or other Pacific Islander

Black or African American

White

More than one race

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Do you have a disability?

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Yes

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Please tell us about any reasonable accommodations you may require to help ensure you have a successful experience and/or give us any other comments you may have.

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