Professional Staff Membership Application

Account Info

First Name


Last Name


Email


Phone


UMID


Professional Info

Title(s)


Degree(s)


Primary Department If you don't see your department, choose "Other"


Office Address - Street Address / Office # only
Ann Arbor, MI

Membership Info

Participation Description - Please briefly elaborate on your professional work and how you specifically might wish to participate in the Depression Center (e.g. special interests, expertise, presentation topics, etc.).


Collaboration Description - Please list recent and active collaborations, if any, with current depression researchers and clinicians at U-M.


Personal Bio