Visiting Research Professor Visit Request Form

 

Thank you for your interest in the Visiting Research Professor. Please fill out the required information below.

NOTE: This online form must be completed in one single session. This form cannot save your information to return to at a later time.


2023 CAG Visiting Research Professor

 

SIMON HIROTA, PhD, CAGF

Associate Professor and Dean of Research Infrastructure, Cumming School of Medicine, University of Calgary

 

Click HERE to read Dr. Hirota's Biography


Visit Request Information

Please submit this form if you are interested in having Dr. Hirota visit your centre.


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