SCTWEB Membership Registration Form


Welcome to the Society for Clinical Trials Online Registration Form. Please complete the following
form and press "Submit" to continue with the online registration process.


Registration Form:

Account Information ( * - required fields )
1) Membership Application Type: *
Last Name *
First name *
Organization *
Address *
Address
City *
State *
Postal Code *
Country
Business Telephone
Fax
Email Address *
Sex
Year of Birth
Most Advanced Degree
If Other, please specify:
Membership Selection
Membership Type
I give permission for my email address
and telephone number to be published
on the Society's web site
I give permission for my mailing
address to be included in the
SCT Mailing List available for rent.
Mailing Address for Journal (if differnt than above)
Mailing Address (line 1)
Mailing Address (line 2)
City:
State
Postal Code:
Country

Additional Survey Information
2) Please check the one primary box that best represents your primary institutional affiliation.


3) Please check all that represent your Job Description.
Biostatistician/Statistician Clinical Coordinator


 

4) Medical Areas of Interest: Please check all that apply

AIDS
Cancer
Cardiovascular Disease
Chronic Disease
Dermatology
Digestive Disease
Endocrine/Metabolic Disorders		 Gerontology
Gynecology/Obstetrics
Infectious Diseases
Kidney/Urologic Disorders
Neonatology
Multi-Specialty
Neurology		 Pediatrics
Pulmonary Diseases
Surgery
Visual Disorders
Others:



 

5) Methodological/Operational Areas of Primary Interest: Please check all that apply.

Clinical Evaluation
Coordination of Clinical Trials
Data Analysis and/or Monitoring
Data Systems Design
Epidemiology
Health Economics/Cost Utilization

Interpretation of Med. Documents
Laboratory Methodology
Medical Ethics

Patient Compliance
Quality Assurance

Quality of Life
Statistics/Methodology
Trial Design
Other


 

6) Committees on which You would be Willing to Serve: Please check all that apply.

Development
Education		 Finance
Membership		 Nominating
Program		 Publication
Student Scholarship

 

 

7) For new members only, how did you learn about the Society for Clinical Trials (please check all that apply):
Colleague
SCT Brochure
Annual meeting announcement		 SCT Website
SCT Mailing
 Clinical Trials Journal
Other
If Other, please specify: