Membership Application

The Heart & Stroke Richard Lewar Centre of Excellence supports research and education on the prevention and cure of cardiovascular disease. As part of the HSRLCE, members have priority access to core facilities and input into future plans for the Centre.

Member trainees will have an opportunity to apply to our competitive Fellowship and Studentship programs. We also encourage members, colleagues, and students to attend our monthly Distinguished Visiting Professor Lecture Series, as well as our Annual Cardiovascular Scientific Day conference.

In order to accurately reflect the needs of our membership we will occasionally request that members participate in special retreats, or working groups/meetings related to our education, research or outreach program.

Please follow the link for a fillable PDF Faculty Application for Membership.pdf

Or complete the online application below

First Name*

Last Name*

Street Address

City

Province

Position*

Institution*

Phone

Email*

Do you currently hold a peer reviewed grant(s) with a cardiovascular subject focus?* Yes No
If yes, with which agencies?

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What areas of cardiovascular research are you currently engaged in? Please provide 5 keywords*
Which CIHR Pillar is your research work? (check all that apply)* Biomedical Clinical Health Systems Population Health
What is your level of training?* MD (or equivalent) PhD MD/PhD
Do you hold a license to practice medicine?* Yes No
If yes, since when?
Do you currently or have you ever led a clinical trial?* Yes No
If yes, please provide details
Have you ever recruited patients into a clinical trial?* Yes No
If yes, please provide details

Do you have a formal School of Graduate Studies Appointment?* Yes No
If yes, what category of appointment do you hold?* Full Member* Associate Member Associate (restricted) Member Member Emeriti
(If within the last 12 months, please provide a copy of SGS or departmental confirmation letter)
Do you presently supervise graduate students?* Yes No
If yes, please provide details
Are you actively involved in graduate teaching?* Yes No
If yes, please provide course detail
Please append a current Curriculum Vitae* (valid extension(s): .pdf, .doc, )