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* 1. Study Title

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* 2. Principal Investigator:

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* 3. Email Address of Principal Investigator:

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* 4. Is the Principal Investigator an E-AHPBA member?

(Please note that either the Principal Investigator or a senior collaborating member of the team must be an E-AHPBA member)

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* 5. Leading Study Centre:

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* 6. Investigator(s):

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* 7. Please indicate which Investigator(s) are E-AHPBA members:

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* 8. Hypothesis:

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* Upload any supporting documents for the hypothesis:

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* 9. Objective(s) / Aims:

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* Upload any supporting documents for the objective(s) / aims:

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* 10. Methodology:

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* Upload any supporting documents for the methodology:

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* 11. Duration:

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* 12. Primary Endpoint:

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* 13. Secondary Endpoints:

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* 14. Number of Subjects:

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* 15. Inclusion Criteria:

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* 16. Exclusion Criteria:

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* 17. Data Collection:

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* 18. Authorship Rules:

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* 19. Requested Help:

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* 20. Additional comments or information for the E-AHPBA Scientific & Research Committee:

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* Acknowledgement:

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