NEURO2024-FAONS
Symposium Application Form

Symposium

Category ＊

1st choice:
----- Please choose ----- A. Molecular and Cellular Biology B. Development, Regeneration and Plasticity C. Sensory and Motor Systems D. Homeostasis and Neuroendocrine Systems E. Molecular and Neuronal Bases of Behavior F. Basic and Clinical Science of Mental Disorders G. Basic and Clinical Science of Neurological Disorders H. Methodology・Others 2nd choice:
----- Please choose ----- A. Molecular and Cellular Biology B. Development, Regeneration and Plasticity C. Sensory and Motor Systems D. Homeostasis and Neuroendocrine Systems E. Molecular and Neuronal Bases of Behavior F. Basic and Clinical Science of Mental Disorders G. Basic and Clinical Science of Neurological Disorders H. Methodology・Others

Title ＊

Aim & Synopsis ＊ *Approx. 400 characters

Keyword ＊

Password ＊ At least 5 characters/numbers.
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Organizer

Name ＊

First & Middle: 　Family:
　　　　　　　　　　　　　　　　　　　　

Affiliation ＊

*Please enter up to faculty, department, lab's name etc.

Position ＊

E-mail ＊

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TEL ＊

URL ＊

Country ＊

Age

--- Please choose --- 20's 30's 40's 50's 60's 70's 80's and over

Gender

• Male
• Female
• Other

Co-organizer

Name

First & Middle: 　Family:
　　　　　　　　　　　　　　　　　　　　

Affiliation

*Please enter up to faculty, department, lab's name etc.

Position

E-mail

TEL

URL

Country

Age

--- Please choose --- 20's 30's 40's 50's 60's 70's 80's and over

Gender

• Male
• Female
• Other

Speaker 1

Name ＊

First & Middle: 　Family:
　　　　　　　　　　　　　　　　　　　　

Affiliation ＊

*Please enter up to faculty, department, lab's name etc.

Position ＊

E-mail ＊

TEL ＊

URL ＊

Country ＊

Age

• 45 years old or younger as of August, 2023
• N/A, Unknown

Gender

• Male
• Female
• Other

Title ＊

Representative Publications
(1 or 2) ＊

Speaker 2

Name

First & Middle: 　Family:
　　　　　　　　　　　　　　　　　　　　

Affiliation

*Please enter up to faculty, department, lab's name etc.

Position

E-mail

TEL

URL

Country

Age

• 45 years old or younger as of August, 2023
• N/A, Unknown

Gender

• Male
• Female
• Other

Title

Representative Publications
(1 or 2)

Speaker 3

Name

First & Middle: 　Family:
　　　　　　　　　　　　　　　　　　　　

Affiliation

*Please enter up to faculty, department, lab's name etc.

Position

E-mail

TEL

URL

Country

Age

• 45 years old or younger as of August, 2023
• N/A, Unknown

Gender

• Male
• Female
• Other

Title

Representative Publications
(1 or 2)

Speaker 4

Name

First & Middle: 　Family:
　　　　　　　　　　　　　　　　　　　　

Affiliation

*Please enter up to faculty, department, lab's name etc.

Position

E-mail

TEL

URL

Country

Age

• 45 years old or younger as of August, 2023
• N/A, Unknown

Gender

• Male
• Female
• Other

Title

Representative Publications
(1 or 2)

Speaker 5

Name

First & Middle: 　Family:
　　　　　　　　　　　　　　　　　　　　

Affiliation

*Please enter up to faculty, department, lab's name etc.

Position

E-mail

TEL

URL

Country

Age

• 45 years old or younger as of August, 2023
• N/A, Unknown

Gender

• Male
• Female
• Other

Title

Representative Publications
(1 or 2)

Speaker 6

Name

First & Middle: 　Family:
　　　　　　　　　　　　　　　　　　　　

Affiliation

*Please enter up to faculty, department, lab's name etc.

Position

E-mail

TEL

URL

Country

Age

• 45 years old or younger as of August, 2023
• N/A, Unknown

Gender

• Male
• Female
• Other

Title

Representative Publications
(1 or 2)

Special Notes

Consideration to diversity: age, gender, internationality and others *Approx. 400 characters

Breaking down the content (number of speakers in specific age groups, genders, and geographical areas) will make your proposal more appealing. (However, please do not force personal information out of speakers).

Special Notes *Approx. 400 characters

Please describe your intended contribution to this meeting, or relevance to clinical practices etc.