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OMB # 0925-0766 EXP. 04/2023
Country Experts Form
Are you aware of the regulatory requirements In Australia and wilting to provide feedback to the ClinRegs team during the country profile update?
If yes, please complete the following form and a member of the ClinRegs team will contact you.
First name·
Last Name•
Email*
Select Cl1nRegs countries of expertise (one or more)
D Australia
D Braz,I
D Canada
D China
0 Guinea
D India
D Kenya
O Liberia
D Malawi
O
Mah
O Peru
D Sierra Leone
D South Africa
D Tanzania
O Thailand
O Uganda
O United Kingdom
O United States
D Vietnam
What 1s your pnmary organizational affihet1on?
Q
NIAID
Q NIH (non-NtAID)
O
US Government, Other
O Industry
0 Academia
O Not-For-Profit
0 Other
What Is your rota?
O
O
O
Investigator
Chn1cal Research Associate or Monitor
Chmcal Research/Study Coordinator
o IRS/Ethics Committee
0 Finance
0
Other
Please specify
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| File Type | application/pdf |
| File Title | SME-form-with-burden-statement-updated 8-31.png |
| Author | washingtondi |
| File Modified | 2020-09-03 |
| File Created | 2020-09-03 |