Trainee Certification Form printable pdf download

Trainee Certification Form

The American Association of Immunologists

Trainee Certification Form

To qualify as a trainee, please submit this form upon payment (of membership dues or event registration).

See bottom of form for submission instructions.*

Please print legibly or type.

AAI User ID (also AAI Member Number, if a member): ______________________________________

AAI Trainee Member Paid for Current Year

□

Yes

□

Trainee Full Name: ____________________________________________________________________

First

Middle

Last

Mailing Address: _______________________________________________________________________

_____________________________________________________________________________________

Trainee Status (check one):

□ Student

(Pre doctoral) - Degree and Year Expected: ___________________

Post doctoral - Degree and Year Received: ____________________

□

Advisor/Department Chair Certification of Applicant’s Trainee Status

I hereby certify that the Trainee named above is a registered student or postdoctoral fellow engaged in a

research training program, clinical fellowship, or residency program.

_____________________________________________________________________________________

Name of Advisor/Department Chair

Advisor Signature: ________________________________________ Date: _________________________

If an AAI member, Advisor AAI User ID / Member Number: __________________________________________

Advisor Institutional E-mail Address: _____________________________________________________________

*To submit, upload a PDF of this signed form directly to your AAI user / member profile: At , click on

‘Update Your AAI Member or Non-Member Profile’ in the upper right, log in, and then click on ‘Upload Trainee

Certification’ under Account Services.

5/19/2014

Trainee Certification Form