Clinical Trials: Ongoing Trials
Requestor Information
* Indicates Required Field
First Name*
Last Name*
Position/Title
Institution/Affiliation
Address*  
City*
State/Province/Region*
Country*
Zip/Postal Code*
Phone*
Email*
Degree*  
Physician Specialty (MDs only)
Potential Conflicts of Interest*
NOTE: This includes all financial relationships in the last 5 years that could be perceived to influence the analysis of data or conclusions drawn from analyses. Please consider:
  • Employment
  • Consulting agreements
  • Research grants (existing or under review)
  • Participation in clinical studies as an investigator
  • Board memberships
  • Patent ownership (or pending applications)
  • Stock ownership, including stock options (not including investment funds or mutual funds)
  • Royalty payments
 
Conflicts of Commitment*
NOTE: This includes other (e.g. non-financial) real or potential conflicts of interest that could be perceived to influence the analysis of data or conclusions drawn from analyses. Please consider potential conflicts based on:
  • Academic situations
  • Prior publications
  • Personal relationships
  • Institutional affiliations
 
Relevant Experience*
Please describe your experience in research (as relevant to this project), in 500 words or less.
 
 
Proposed Project Team

  NOTE: Please list all individuals that will have access to the data, including the requestor.

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 First Name*Last Name*Position or Title*Employer*Conflicts of Interest (see description above)Conflicts of Commitment (see description above)Upload CV*




Proposed Project Information
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Product*
Therapeutic Area*
Indication*
NCT or EudraCT Number*
 
Research Question/Hypothesis*
 
Lay Summary*
 
Research Plan*
 
Statistical Analysis Plan*
 
Publication Plan*
 
Funding Sources*