New interRAI Fellows Onboarding Form | interRAI

New interRAI Fellows Onboarding Form

Congratulations on your nomination as an interRAI Fellow! As part of your member onboarding, please complete the below form.

Full name and degrees for print *

This is how you will be credited should you collaborate as an author on an interRAI publication. Please include your full name and all required academic credentials.

Academic Title(s) *

Academic Affiliation *

Work Site & Title *

Email *

Additional Email

Phone - fax

Phone - home

Phone - mobile

Phone - work

Bio: brief text OR link to online bio *

Nation *

Primary iNE *

Additional iNEs

Name of spouse/significant other

First

Last

Address - home

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Address - work *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country