Council Member Form

This form is for incoming EBRC Council Members to provide information to EBRC. Some of the questions may duplicate information already provided (e.g. email address). We kindly ask that you provide your preferred information again so we can update our records.

Profile Information

Primary Email Address*

Is your email address associated with a Google Account?

EBRC regularly uses the Google platform for document and file sharing.

Yes
No
I don't know.

Google-linked Email Address

Please provide a Google-linked address for access to relevant EBRC materials.

First Name*

As used in publications, will be displayed on site.

Last Name*

If different: Name you prefer to be called

As you use on a name badge

Professional Title*

Research Institution*

Country*

U.S. State*

Primary Department

Please enter as "Department of...."

Phone*

Include area code, and country code if outside the U.S.

Phone Type*

Office
Cell
Home

Twitter Handle

Lab Website

Short Bio*

Professional Portrait

For best results, upload a square image minimum 600x600 pixels. Otherwise, photo will be automatically cropped and resized.

Accepted file types: jpg, jpeg, png, gif.

Primary Working Group Selection*

Please identify a primary working group that you will be involved with. You are welcome to attend other working group meetings, but we understand that your “EBRC-time” is limited. Specifying one as primary will help to ensure that we have appropriately dedicated Council members across the working groups.

Technical Research Roadmapping
Education
Security
Policy & International Engagement

EBRC Application & Council Questions

These questions are for our Membership Committee and/or Internal-Use only.

In what year did you start your first independent position?*

Do you currently have independent (full) Principal Investigator status at your institution?*

Yes
No

Do you currently have tenure (or a similarly categorized position)?*

Yes
No

Demographics

EBRC collects demographic information to better understand the diversity of our community. All questions are optional.

Gender self-identification

Which category best describes your race?

For definitions of the following categories, please see: https://www.opm.gov/forms/pdf_fill/sf181.pdf

American Indian/Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
White
Decline to specify
Unknown/unavailable

Which category best describes your ethnicity?

For definitions, please see: https://www.opm.gov/forms/pdf_fill/sf181.pdf

Comments

This field is for validation purposes and should be left unchanged.