Form 1 BPCA survey

BPCA Stakeholder Contact Information Request
OMB # 0925- 0766
Expiration Date: 04/2023
Public reporting burden for this collection of information is estimated to average
two minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974,
ATTN: PRA (0925- 0766). Do not return the completed form to this address.
Thank you for your interest in the BPCA program! Please provide your contact
details below in order to receive future program updates.
Questions? Feel free to reach out to us directly at bpca@infinityconferences.com.
First Name

Last Name

1

Designation (select all that apply)
M.D.
Ph.D.
Pharm.D.
D.O.
Other (please specify)

Job Title

Company/Institution

Department

City

State (if U.S.)

Country

Email Address

2

Area of Expertise

Would you like to be involved in the 2021 BPCA prioritization process?
Yes
No

3