IPHAM Center Membership

Please note:
- Membership is open to Northwestern-affiliated faculty only (including Northwestern Medicine, Lurie Children's, and Shirley Ryan Ability Lab)
- If you are already an IPHAM member and you fill out this form, the selections you make below will replace your previously-selected affiliations.
- If you have questions, please email ipham@northwestern.edu.

Name Name First Last
Email
Northwestern netid (mark N/A if this does not apply)
Primary Center Affiliation

Your primary center may be determined by your use of IPHAM research administration or the location of your office in IPHAM-allocated space. Alternatively, it may simply be your choice, based on your area of interest in collaboration, education, or research. Your primary center will be visible on your FSM faculty profile. A primary center affiliation is required in order for IPHAM to be displayed on your faculty profile.
Secondary Center Affiliation(s)

Secondary Center Affiliation(s) Applied Health Research on Aging Bioethics and Medical Humanities Buehler Center for Health Policy and Economics Community Health Dissemination and Implementation Science Education in Health Sciences Food Allergy and Asthma Research Health Services & Outcomes Research Patient-Centered Outcomes Primary Care Innovation Translational Metabolism and Health Osher Center for Integrative Health

You will be listed on the Center website as a member and receive all center communications. Choose as many secondary centers as appropriate based on your areas of interest.
Please confirm that you are Northwestern-affiliated faculty

Please confirm that you are Northwestern-affiliated faculty Yes