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* 1. Study Title

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* 2. Principal Investigator:

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* 3. Is the Principal Investigator and E-AHPBA member?

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* 4. Leading Study Centre:

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* 5. Investigator(s):

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

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* 7. Hypothesis:

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* 8. Objective(s) / Aims:

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* 9. Methodology:

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* 10. Duration:

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* 11. Primary endpoint:

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* 12. Secondary endpoints:

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* 13. Number of Subjects:

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* 14. Inclusion Criteria:

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* 15. Exclusion Criteria:

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* 16. Data Collection:

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* 17. Authorship rules:

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* 18. Requested help:

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* 19. Remarks:

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