Be an Investigator - Register
 
 
Clinical investigators play a vital role in bringing new and potentially life-saving medicines to markets faster, which in turn enables millions of people all over the world to live longer, healthier and happier lives. We are always keen to increase our investigator pool and to work with the finest, most qualified investigators to advance the field of medicine. If you would like to be considered for future clinical trials run by ICBIO, Click Here for Registeration.
 
REGISTER
 
Investigator Registration Questionnaire Please complete the attached Investigator Registration Questionnaire and Investigator Data Protection Consent Form and return to us by fax or email.
 
 
Investigator First Name  
Investigator Middle Initial  
Investigator Last Name  
Title:  
Dr. Mr. Mrs. Ms. Prof.
Institution / Hospital name  
Investigator Address 1  
Investigator Address 2  
Investigator City  
Investigator State /Providence  
Investigator Zip /Postal Code  
Country  
Region  

Phone

  

Fax

  

Unique Investigator email address

  
    (the email address will be used as unique
identifyer in the database. Shared or group
email addressess are not appropriate)
Medical License  
Qualification / Degree  
Do you have EDC experience?  
Yes No
Do you use Central or Local IRB?  
Have you been audited by FDA /
EMEA / local regulatory agencies?		  
Yes No
Audit Date  
Please specifiy agency  
Site settings  
GP Hospital Private Practice
   
University / Academic SMO Phase I unit Other
SMO / Network affiliated  
Yes No
Name of SMO / Network  
Study Coordinators  
Yes No
Study coordinators  
Total years Clinical Research Experience  
Trials worked on  
   
 
 
 
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