Sign Me Up!

If you are interested in participating in a research study please fill-in the following imformation and submit it to our researchers. Your information will only be used to match you with experimental requirements and for contact purposes - it will never be made public or used in any other manner! First Name     Last Name Email      Phone Date of Birth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940          Male       Female Previous Participation Experience?    ERPs    Psych We are generally looking for participants between the ages of 18-35, with normal vision (corrected okay), no history of mental illness, no history of serious head injury, with normal hearing. From time-to-time we do run experiments where some of these things might not disqualify you from participation - just let us know in the "Additional Comments" field and we can discuss when we contact you! Additional Comments If you have further questions or would prefer to speak with someone in our lab prior to submitting this information, please contact us via email at participate@sdepl.ucsd.edu or via phone, 858-534-5562. We will be happy to explain what studies we currently have available, discuss particpant requirements, and schedule appointments. Thank you, and we look forward to seeing you in the lab!

School of Medicine, Department of Neurosciences 9500 Gilman Drive #0608, La Jolla, CA 92093-0608

Email: erplab@sdepl.ucsd.edu   Phone: 858-534-5562    Fax: 858-534-1566 © 2005-2010 Regents of the Univ of California San Diego USA