Careers

Investigator Sign-Up Form

Please read carefully.

By filling out and submitting the form below, I agree that the information I provide will be added to a global clinical trial investigator database. I understand and permit the use of my personal information for this purpose and further understand that the information I provide may be reviewed for consideration as part of an existing or upcoming clinical trial. Finally, I understand that the information that I provide may be disseminated to third parties when necessary, including but not limited to: sponsors of clinical trials, applicable regulatory agencies and other associated subsidiaries and affiliates of Clinsys.



Section 1: Investigator Information

last name:

first name:

degree:

site/institution:

street address:

city:

state/province:

zip:

country:

phone:

fax:

email:

Section 2: Primary Contact Information for Site/Facility

last name:

first name:

title:

site/institution:

street address:

city:

state/province:

zip:

country:

phone:

fax:

email:



Section 3: Specialties
(please select all that apply)




































the specialty:



Section 4: Facility Setting
(please select the most accurate)






the type of facility:



Section 5: More Information

How many years of clinical research experience does the principal investigator have?



Which phase(s) of clinical research does the principal investigator have experience in?
(please check all that apply)

Have you been audited by Regulatory Authorities?



If yes, when was the audit?



Have you been audited by a sponsor?



If yes, when was the audit?


Section 6: Other Comments




Section 7: Optional CV Upload

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