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International ALS MND Symposium Fellow Application 2021

Thank you for your interest in the fifth annual Patient Fellows Program for the International ALS MND Symposium.

This program is led by volunteers who believe in not only the value that the Symposium provides to people with ALS but also the value that they provide back to the scientific discussions.

The program is coordinated administratively by I AM ALS.


Please review the Patient Fellows website at http://www.alspatientfellows.org regarding the program, its purpose, and the selection process before filling out your application.

If you have questions or need more information, please use the Contact form at the Patient Fellows website  http://www.alspatientfellows.org

Please complete your survey in English.  The ALS MND Symposium is conducted in English.

Thank you very much.
This application is divided into five sections:
1. Your contact information
2. Your ALS MND
3. Your background in science
4. Your interests and why you should be a part of this program
5. Your agreement with the terms of the fellowship

To view a pdf to preview the entire application,  click here.

 
Part 1. Contact Information
1. In 2021 the Patient Fellows Program has room for 15 people with ALS plus two new spots reserved --
one for a caregiver and another for an asymptomatic ALS gene carrier.

I am a *This question is required.