CLINICAL SITE ATTENDEE REGISTRATION
ISPCTN Steering Committee Meeting
May 12-13, 2020
Renaissance Arlington Capital View Hotel
Arlington, VA

PLEASE COMPLETE BY April 10, 2020

Please complete the registration below to attend the ISPCTN face-to-face Steering Committee Meeting scheduled for May 12-13, 2020 at the Renaissance Arlington Capital View Hotel in Arlington, Virginia (Greater DC Area).

This registration is important so that the DCOC can begin direct communication with you regarding the conference. It also helps us form your site's complete registration packet to include name badges, work group rotation and seating assignments.

NOTE: This meeting registration does not reserve your hotel room.

The hotel registration link is listed in the ISPCTN Weekly Checkist and the Monthly Bulletin and you will need to reserve your hotel room separately from this registration.

DEADLINE FOR HOTEL: April 13, 2020

MEETING DATES:

May 12: 8:00 a.m. - 5:00 p.m. (Network Reception 5:30-6:30)

May 13: 8:00 a.m. - 3:00 p.m.

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* 1. Institution Name

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* 2. Clinical site name and location

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* 3. Attendee name with credentials

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* 4. Attendee email address

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* 5. ISPCTN Role

ISPCTN Principal Investigator

ISPCTN Co-Investigator

ACT NOW ESC Principal Investigator

ACT NOW ESC Co-Investigator

ACT NOW Weaning Principal Investigator

ACT NOW Weaning Co-Investigator

iAmHealthy Investigator

iAmHealthy Co-Investigator

VDORA1 Principal Investigator

VDORA1 Co-Investigator

Clinical Site Manager

Research Coordinator

Data Manager

Pharmacist

Other

If other, please state here:

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* 6. Hotel Reservations
Due to flight reservation availability, do you anticipate needing a hotel room for the evening of May 13 with a check out date of May 14? (Note: This will help the DCOC block enough rooms to accommodate these attendees)

Yes

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* 1. Institution Name

Question Title

* 2. Clinical site name and location

Question Title

* 3. Attendee name with credentials

Question Title

* 4. Attendee email address

Question Title

* 5. ISPCTN Role

Question Title

* 6. Hotel ReservationsDue to flight reservation availability, do you anticipate needing a hotel room for the evening of May 13 with a check out date of May 14? (Note: This will help the DCOC block enough rooms to accommodate these attendees)

Question Title

* 7. Please list below the exact way you would like your name badge to read including credentials.

* 6. Hotel Reservations
Due to flight reservation availability, do you anticipate needing a hotel room for the evening of May 13 with a check out date of May 14? (Note: This will help the DCOC block enough rooms to accommodate these attendees)