Registration

If you would like to become a contributing member of either the PAIN Archived or Standardized Repositories, please fill in and submit the form below.

If you are interested in collaborating with UCLA CNS please send an email to info@painrepository.org. The MAPP Network is not open to new members.

*First Name:
*Last Name:
Highest Degree Completed:	PhD or Equivalent MD, PhD MD Masters (MS, MA, MBA, MPH) Bachelors (BS, BA)
*Academic Title/Position:
*Affiliated Institution/Company:
Name of Group/Laboratory:
*Country/Nation:
*Email:
*Confirm Email:
I would like to become a member of:
Standardized PAIN Repository	Archived PAIN Repository
Primary reason for joining PAIN:
*Compute:	+ =

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