clinical research events registration

Clinical Research Events Registration Form

Please fill up the form for the clinical research events registration.

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Personal Information :-

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Office Information :-

Official Address (required)

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Name of your Institution/Company/Organization (required)

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Current Job Position (required)

Country where your Institution,Company or Organization is located (required)

Other Information

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Personal Information :-

Degree (required)

Member

Please specify for others

Salutation (required)

First Name (required)

Middle Name

Last Name (required)

Date Of Birth (required)

Email (required)

Alternate Email

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Mobile (required)

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Country (required)

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Pin Code (required)

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Office Information :-

Official Address (required)

Country (required)

State (required)

City (required)

Pin Code (required)

Name of your Institution/Company/Organization (required)

Nature of Institution/Company/Organization (required)

Current Job Position (required)

Country where your Institution,Company or Organization is located (required)

Other Information

Remarks

Personal Information :-

Degree (required)

Member

Please specify for others

Salutation (required)

First Name (required)

Middle Name

Last Name (required)

Date Of Birth (required)

Email (required)

Alternate Email

Phone

Mobile (required)

Correspondance Address (required)

Country (required)

State (required)

City (required)

Pin Code (required)

Gender (required)

Office Information :-

Official Address (required)

Country (required)

State (required)

City (required)

Pin Code (required)

Name of your Institution/Company/Organization (required)

Nature of Institution/Company/Organization (required)

Current Job Position (required)

Country where your Institution,Company or Organization is located (required)

Other Information

Remarks

Personal Information :-

Salutation (required)

First Name (required)

Middle Name

Last Name (required)

Gender (required)

Degree (required)

MCI Registration Number for CME Credits (required)

Specialisation, Department (required)

Email (required)

Alternate Email

Phone

Mobile (required)

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Country (required)

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Pin Code (required)

Current Institution (Medical College/Hospital) Name (required)

Current Designation (required)

Other Information (required)

Institution for MBBS (required)

Institution for MD/MS and/or Post-graduate diploma (required)

Institution for any other degree/specialization (DM/MCh or PhD) or certification (required)

Number of years since highest specialisation/degree (required)

Have you undergone any research training

Duration (required)

Topics covered (max 6) (required)

Institution (required)

Year (required)

Details of Research Grants: If none so far, please tick this box

Name of grant (required)	Area (topic) (required)	Role (PI/ Co-Investigator) (required)	Agency that gave the grant (required)	Duration (required)	Amount (required)

Publications (required)

Total papers (required)

Total Original Articles (required)

Total Other Publications (required)

Total As First Author (required)

Total As Co-Author (required)

For your top 5 papers mention journal name/ year and area (topic) (required)

Expectations from this course (Please write up to 3 points; be specific and mention topics you would like to learn; avoid general statements such as, I want to be a better researcher etc.)

Remarks

5th & 6th December 2019 - Medical Writing: Beyond Protocols, Investigator's Brochures and Study Reports - Hyderabad

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Office Information :-

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15th & 16th November 2019 - Key Safety Documents in Regulatory Writing - Bengaluru

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11th November 2019 – Adopting CORE Reference – Clarity and Openness in Reporting: E3 Based in Writing Disclosure-friendly Clinical Study Reports - Noida

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Office Information :-

Official Address (required)

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18th & 19th October 2019 - A Two-Day Hands-on Workshop on Research Manuscript Writing - Ahmedabad

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Degree (required)

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Alternate Email

Phone

Mobile (required)

Correspondance Address (required)

Country (required)

State (required)

City (required)

Pin Code (required)

Gender (required)

Office Information :-

Official Address (required)

Country (required)

State (required)

City (required)

Pin Code (required)

Name of your Institution/Company/Organization (required)

Nature of Institution/Company/Organization (required)

Current Job Position (required)

Country where your Institution,Company or Organization is located (required)

Other Information

Remarks

6th & 7th September 2019 - Workshop on Clinical Research Methods and Grant Writing for Early Career Academic Medical Researchers - Puducherry

Personal Information :-

Salutation (required)

First Name (required)

Middle Name

Last Name (required)

Gender (required)

Degree (required)

MCI Registration Number for CME Credits (required)

Specialisation, Department (required)

Email (required)

Alternate Email

Phone

Mobile (required)

Correspondance Address (required)

Country (required)

State (required)

City (required)

Pin Code (required)

Current Institution (Medical College/Hospital) Name (required)

Current Designation (required)

Other Information (required)

Institution for MBBS (required)

Institution for MD/MS and/or Post-graduate diploma (required)

Institution for any other degree/specialization (DM/MCh or PhD) or certification (required)

Number of years since highest specialisation/degree (required)

Have you undergone any research training

Duration (required)

Topics covered (max 6) (required)

Institution (required)

Year (required)

Details of Research Grants: If none so far, please tick this box

Name of grant (required)	Area (topic) (required)	Role (PI/ Co-Investigator) (required)	Agency that gave the grant (required)	Duration (required)	Amount (required)

Publications (required)

Total papers (required)

Total Original Articles (required)

Total Other Publications (required)

Total As First Author (required)

Total As Co-Author (required)

For your top 5 papers mention journal name/ year and area (topic) (required)

Expectations from this course (Please write up to 3 points; be specific and mention topics you would like to learn; avoid general statements such as, I want to be a better researcher etc.)

Remarks

Clinical Research Events Registration Form

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