Pelotonia Institute for Immuno-Oncology Membership Application

Name (First, Middle, Last)*

Title

College

Department

Division

Email*

Phone Number*

Office Street Address

Room Number

Administrative Assistant

Admin Email

Admin Phone Number

Requested Center of Research Excellence

Center alignment is based largely on candidate’s research area; however, requests for assignment will also be taken into consideration by the PIIO Membership Executive Committee.

List active funded research projects related to immuno-oncology (federal, foundation, corporate)*

List active clinical trials in immuno-oncology and your role*

List immuno-oncology projects you will be developing in the next 2 years*

Please attach a copy of your current NIH Biosketch*

Application and copy of current NIH Biosketch submitted to PIIO Administration for dissemination to PIIO Membership Executive Committee. All applications will be reviewed by the PIIO Membership Executive Committee on a monthly basis. All applicants will receive a formal notice of the committee’s decision after the review.

Sender Name

gclid

page_url

Questionnaire