ISARIC membership application

ISARIC membership application form

Network Information

What is the academic field of work?
What is your clinical focus?
Trials completed?
Access to patients?
What is the number of research sites/hospitals which you have access to
In the last five years, what is the clinical research experience within the Network/Organisation?
Which type of industrial partnerships, if any, are in place for research, or the implementation of trials within your network?
(Use control-click or command-click to select multiple countries)
Do you require any support?
How did you hear about the Federation?

Contact Details

Please note that the Contact Person indicated below will be considered the Board Representative for your network. Please contact the ISARIC Global Support Centre should you wish for someone else to represent the network in ISARIC’s governing body.

Data protection & Declaration