Researcher Information Form

Personal Information

Title

Mr

Mrs

Ms

Dr

Pronoun

He/Him

She/Her

They/Them

Full Name *

Professional Details

Position

Institute

Department

Role Description

Research Information

Research Focus

Hepatology

IBD

Diabetes

Cancer

Other

Bio

This should be between 150 to 300 words in length

Would you like to have your current research project highlighted in a future Panui/Newsletter?

Yes

No

If yes, we will be in touch for more information. However for now, please let us know

Name of Project

Reason this is important to the gastroenterology community

Collaboration Opportunities

Will you be seeking collaborators?

Yes

No

Will there be student opportunities?

Yes

No

Contact Information

Personal/Lab Website

Email *

Phone Number *

I give permission for my contact details to be included on the NZSG website.

Yes to email and phone

Yes email only

No

Documents

Note: Maximum file size per upload is 6 MB.

CV

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Photo

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I understand submitting this form gives NZSG my consent to post my image and information on the NZSG website*