Membership Application UF Health Cancer Center Membership Application If you have any questions or need assistance with completing this form, please contact firstname.lastname@example.org or call 352-273-8010. Last Name*First Name*Middle NameUF ID*Please enter your UF ID or Shands ID numberAcademic Title*Degree*College*PLEASE SELECTAGRICULTURAL AND LIFE SCIENCESARTSBUSINESS, WARRINGTON COLLEGEDENTISTRYDESIGN, CONSTRUCTION AND PLANNINGEDUCATIONENGINEERING, HERBERT WERTHEIM COLLEGEHEALTH AND HUMAN PERFORMANCEJOURNALISM AND COMMUNICATIONSLAW, LEVIN COLLEGELIBERAL ARTS AND SCIENCESMEDICINENURSINGPHARMACYPUBLIC HEALTH AND HEALTH PROFESSIONSVETERINARY MEDICINEDepartment*PLEASE SELECTAdministrationAdult & Elderly NursingAdvertisingAffiliations & Provider RelationsAgricultural & Biological EngineeringAgronomyAHC Web ServicesAlumni AffairsAnatomy & Cell BiologyAnesthesiologyAnthropologyApplied Physiology & KinesiologyBehavioral Science & Community HealthBiochemistry & Molecular BiologyBiomedical EngineeringBotanyChemical EngineeringChemistryClinical & Health PsychologyClinical Trials ResearchCommunicative DisordersCommunity Dentistry & Behavioral ScienceCommunity Health & Family MedicineComputer & Information Science & EngineeringContinuing Medical EducationElectrical & Computer EngineeringEmergency MedicineEpidemiologyEpidemiology & BiostatisticsEpidemiology & Health Policy ResearchFood Science & Human NutritionForest Resource & ConservationGenetics InstituteHealth Care Environments & SystemHealth Education & BehaviorHealth Outcomes & Biomedical InformaticsHorticultural SciencesICBRInstitute on AgingInternal Medicine — JAXJournalismMaterials Science & EngineeringMechanical & Aerospace EngineeringMedicinal ChemistryMedicineMicrobiology & Cell ScienceMolecular Genetics & MicrobiologyNeurological SurgeryNeurologyNeuroscienceNursingObstetrics & GynecologyObstetrics & Gynecology — JAXOral & Maxillofacial Surgery & Diagnostics SciencesOral BiologyOrthopedic SurgeryOrthopedic Surgery — JAXOrthopedicsOtolaryngologyOtolaryngology — JAX (OTO)PathobiologyPathology — JAXPathology & Laboratory MedicinePediatricsPeriodontologyPharmacology & TherapeuticsPharmacy Health CarePharmacy PracticePhysical TherapyPhysiologyProsthodonticsProgram InformationPsychiatryPsychologyRadiation OncologyRadiation Oncology — JAXRadiologySmall Animal Clinical SciencesStatisticsSurgerySurgery — JAXUF Health Cancer CenterUrologyZoologyNot ListedPhone*Phone Ext.Email* Lab PhoneLab Ext.FaxURL eRA Commons Login NamePublic myNCBI Link*If you do not currently have a myNCBI Link, please write "none."Please identify all professional, cancer-related organizations in which you hold membershipe.g., AACR, ASCO, ASH, ASTRO, IASLC, ONS, etc.Research Interest Topics*Please select up to 10 research interest topics. If your interests are not listed, please contact email@example.com. To select more than one research interest topic, please follow these instructions: After you select your first choice, click back into the field (not on the X), where the drop down menu will populate all remaining research interest topics. Then continue making as many additional selections as desired, repeating the previous process.Anesthesiology/Pain ManagementAngiogenesisApoptosis & Cell Death PathwaysBehavioral Determinants of CancerBioinformaticsBiostatisticsBone & Soft Tissue SarcomasBreastCancer CommunicationsCancer GeneticsCancer InformationCancer PreventionCancer SurveillanceCancer SurvivorshipCancer SusceptibilityCell Signaling PathwaysChemotherapyDNA Damage & RepairDNA RecombinationDNA ReplicationDrug DesignDrug ResistanceEndocrineEnvironmentEpidemiologyEpigenetics & CancerEpigenetics & Gene RegulationEyeGastro-IntestinalGene TherapyGenetic Determinants of CancerGenital-Urinary/ProstateGynecologicalHead & NeckHealth DisparitiesHematologic Malignancies/Blood & Marrow TransplantImmunoregulation & SuppressionImmunotherapyInfection ControlIntegrative MedicineKidneyLeukemiaLiverLungLymphomaMetastasisMicroRNAsMolecular ChaperonesNanotechnologyNeuro-OncologyNoninvasive Imaging/TomographyNutrition, Dietary Supplements & CancerOncolytic Viral VectorsPainPalliative MedicinePediatric OncologyPlastic Surgery/ReconstructionPost-Transcriptional Gene RegulationQuality of Life IssuesRadiation OncologyRehabilitationRNA ProcessingSenescenceSkin/MelanomaStem CellStructural VirologySurgical OncologyTargeted Cancer TherapyThoracic OncologyThyroidTumor Virology/Virus-Host InteractionsVascular TargetingCancer Research Percentage*Help us understand the amount of your research that is focused on cancer-specific activities. <25% of my time 26-50% of my time 51-75% of my time 76-100% of my time Cancer-Relevant Publications*List your top three publications in the last five years that most demonstrate a strong cancer focus. Press the plus sign to add additional publications. Statement of Cancer-Related Activities*In the following space, please describe your cancer-related activities the committee should take into consideration when evaluating you for membership. Please summarize in lay terms the primary focus of your research and the cancer- relevance of that research.Program Alignment*Please identify the UFHCC Research Programs for which your ongoing research is best aligned. If you are unsure, please select "unsure."Please SelectCancer Population Sciences (CPS)Cancer Therapeutics & Host Response (CTHR)Mechanisms of Oncogenesis (MOO)UnsureCV*Please upload your most current CV.Accepted file types: pdf, doc, docx.NIH Biosketch*Please upload your current NIH Biosketch.Accepted file types: pdf, doc, docx.