Student ID Enrollment Form

SPECIAL DISCOUNT FOR STUDENTS!

We are now offering membership in the Cogence Immunology community at a special discount of $1500 for full time students who are currently enrolled and earning a clinical degree. If you are a currently enrolled full time student, use the fields on this page to enter your personal information and to upload a photo of your valid student ID (not a picture of you, a picture of your ID). In order to receive your student price, please submit this form before placing your order. Once you submit your form, we will contact you with more information on how to get your discount!


Have additional questions? We’re here to help! If you need assistance please don’t hesitate to contact us.

Institution Name

Institution Phone Number

Degree or Certification You're Working Toward

Month & Year of Expected Completion

First Name

Last Name

Email Address


Photo ID (required)
Supported file types: JPEG, PNG, PDF
Please take a clear, readable picture of your STUDENT PHOTO ID and upload it here. Maximum upload size: 2MB


Message (optional)



I've read and accept the Terms & Conditions.


Verification Code

 

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