I-SCORE: Investigators' and Site Coordinators' Opportunity for Research Excellence Meeting (Registration)

OMB No.: 0925-0740
Expiration Date: 9/30/2025

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Your Information

First Name:

Last Name:

Degree:

Work Address Line 1

Address Line 2

City/Town

State/Province

ZIP/Postal Code

Country

Work Phone:

Ext:

Cell Phone (Optional):

Work Email Address:

Confirm email

My name, institution, work and cell phone, and work email may be shared with other attendees:

NIH Employee:

Organization/Institution:

Department:

Affiliation: Please indicate all affiliations:

CP-CTNet

DCP Early Phase Consortia

Organization/Institution

How do you plan to attend:

In-Person

Virtually

Are you a NIH Badge Holder, U.S. Citizen, or Permanent Resident with a green card?

Yes

No

Attention: Visitors who are Non-NIH badge holders, U.S. Citizens, or Permanent Residents with a green card must submit documentation of a U.S. Visa or Visa Waiver Program at least 10 business days before visiting the NCI facility. You will receive an email with instructions on how to submit your documentation shortly after you register for the event. Please be advised that failure to submit the required information at least 10 business days before your scheduled arrival may result in denial of entry to the NCI campus.

Attendee Type

Attendee

Speaker

Photography Approval

Please check one of the below boxes to indicate whether you give permission for the use of your photo(s) taken by the professional photographer at the I-SCORE meeting and/or any candid photos taken by any attendees at the Social Hour event for use in the CP-CTNet Newsletter (which is emailed to CP-CTNet members and is also posted on the CP-CTNet DMACC website: https://www.cp-ctnet-dmacc.org/public/updates/newsletters )

Should you not give approval please do not take part in the group photo of all attendees. Thank you.

I approve

I do not approve

Accommodations

Do you need any special assistance?

I do not need assistance

Wheelchair access

Hearing Impaired

Visually Impaired

Other…

Additional Speaker Questions

Program Assistant Name:

Program Assistant Email Address:

Program Assistant Work Phone Number:

Program Assistant Cell Phone Number (Optional):

My presentation slides may be shared with all attendees upon request.

Yes

No