Registration Form (UCSD POETAF)
Principal Investigator Information Only

Required field*
First Name*
M.I.
Last Name*
Academics	(Ph.D.,M.D.)
Email Address*	(jdoe@ucsd.edu)
Peer Reviewed*	No Yes  If yes, enter Start Date:
Department*
Academic Title	(Professor, Asst. Professor)
Mail Code*
Office Location
Phone*
Fax Number
SR Objective	Unknown Biomarker Lab Biomedical Informatics Biorepository Biorepository and Tissue Technology Biostatistics / Bioinformatics Clinic Clinical Trials Office Design, Biostatistics and Ethics DNA Sequencing Exercise and Physical Activity Resource Center Flow Cytometry Genomics /BCC Histology / Immunohistochemistry In Vivo Imaging Information Technology Liquid and CO2 Recharge MEG Microscopy MRI at Bydder Lab MRI at La Jolla MRI at RIL No IDC Nutrition Assessment Nutrition Counseling Nutrition Laboratory PET Pharmacology Procedures Radiation Medicine Transgenic Mouse
Referral Name