NIH eRA Commons Registration Request

Fields marked with * are required.

If you are human, leave this field blank.

I am requesting registration for an NIH eRA Commons role (please choose one): *

First Name *

Last Name *

Requested Username 1 *

Requested Username 2 *

Email Address *

Department/School *

Campus Street Address *

Address line 2

City *

State/Province/Region *

Postal/Zip Code *

Phone Number *

Do you already have a Commons username/user id which you received either while you were at the MBL or at another institution?

Yes

If yes, please provide the username and email address for your Commons Account:

Email for Commons Account:

Please enter any additional information or comments below:

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