Form 1 Registration

Conference, Meeting, Workshop, and Poster Session Registration Generic Clearance (OD)

2021 Spring ETCTN Registration

2021 Spring ETCTN (Experimental Therapeutics Clinical Trial Network) Portfolio Presentation/IDSC (Investigational Drug Steering Committee) Meeting (NCI)

OMB: 0925-0740

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2021 Spring ETCTN (Experimental Therapeutics Clinical Trial Network) Portfolio Presentation/IDSC (Investigational Drug Steering Committee) Meeting

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OMB No.: 0925-0740

Expiration Date: 07/31/2022

Public reporting burden for this collection of information is estimated to average 2 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 (0925-0740). Do not return the completed form to this address.


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Fill out the information below, then click Next to proceed. If you experience any difficulties when registering for the meeting, please contact Julia Poms julia.poms@nih.gov or Michelle

Watson: m ichelle.watson@nih.gov for assistance.


Personal Information


First Name:

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Last Name:

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Email Address:


Assistant Email:

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Degree:


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*Affiliation/Institute:


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*Job Title:


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*Department/Division:


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Contact Information


Work Address:

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*Address:




*City:


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State/Province:


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*ZIP/Postal Code:


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*Country:


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*Work Phone:


Pursuant to the Americans with Disabilities Act, do you require specific aids or services?

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Will you be attending the March 26, 2020 dinner?

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMitchell, Annette (NIH/NCI) [E]
File Modified0000-00-00
File Created2022-02-01

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