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 InformationPrimary 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 AddressPlease 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 calledAs you use on a name badge Professional Title* Research Institution* Country*United StatesAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweU.S. State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPrimary DepartmentPlease 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 PortraitFor 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 QuestionsThese 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 DemographicsEBRC collects demographic information to better understand the diversity of our community. All questions are optional.Gender self-identificationPlease selectMaleFemaleNon-binary / third genderPrefer not to sayWhich 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.pdfPlease selectHispanic or LatinoNot Hispanic or LatinoEmailThis field is for validation purposes and should be left unchanged.