Clinical Quality Registries Special Interest Group (CQR SIG) Membership Application

The purpose of the CQR SIG is to drive best practice in registries through a community of CQR experts in Australia. Membership is voluntary and we welcome all registry staff to apply. To become a member of this SIG, please complete the following questionnaire.

Note: There are no fees for membership. Being a member of CQR SIG does not require (affiliate) membership of ACTA but we encourage you to consider supporting ACTA in this way. Please visit: https://clinicaltrialsalliance.org.au/membership/ for further details.

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* 1. Your personal details

Title

First Name

Last Name

Work Address

City

State

Post Code

Country

Work Phone

Work Email

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* 2. Current Position Title

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* 3. Which of the following professional categories best describes your connection to the registry sector? (Please select One option only)

Registry Manager

Project Manager

Project Officer/ Coordinator

Data Manager

Statistician

Data Analyst

Clinician

Academic Researcher

Data Custodian

Consumer representative

Industry representative

Jurisdictional representative

Government representative

Other (please specify)

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* 4. Select the option that best reflects your involvement with registries:

Currently involved

Previously involved

Planning stage

Not directly involved

Other (please specify)

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* 5. Please list the name of the organisation/ peak body that you are employed by (i.e. Monash University, Australian Orthopaedic Association, SAHMRI, RACS, etc).

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* 6. Please indicate which registry/ registries you are currently working in (or with) (Name/ Abbreviation and URL if possible). If none, please write "none".

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* 7. What skills or expertise do you have which supports the CQR SIG?

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* 8. What are your areas of interest in the registry sector?

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* 9. Would you like to be added to our monthly ACTA newsletter to be informed of sector news and events?

Yes

Thank you for completing this questionnaire. It will be sent to the CQR co-chairs for review and you will be informed of the outcome in due course.