.

Are you interested in being an ELSN Member for 2024-2025?

Additional information about ELSN can be found on our website

Are you a current ELSN member who wants to continue your membership for another year?

Yes

No

Your Full Name*

Email Address*

Campus or Health Staff*

Campus

Health

Department*

Please do not abbreviate

Your Job Title*

Do you support any leaders? If so, please list their name(s).*

Other Location

Which ELSN role are you interested in being a part of?*

ELSN Member (member who will join meetings and events when I'm available)

ELSN Steering Committee (active member to help lead the mission of ELSN and assist with specific tasks)

We are planning to host an ELSN Retreat in Fall 2024 or Spring 2025. Are you interested in being part of the ELSN Retreat Planning Committee?

Details and information will be sent to you in the coming months once we're ready to assemble the planning committee team.

Response*

Yes

No

Please submit your comments, feedback or questions here:

For additional questions about ELSN, please don't hesitate to email:

Oriol Zales at oriol.zales@ucsf.edu

Cindy Cheng at cindy.cheng@ucsf.edu

Send me a copy of my responses