September 2017 - June 2018

Form Approved
OMB Number 0925-0698
Exp. Date 5/31/2017

Remote Site Participant Registration

INTRODUCTION TO THE PRINCIPLES AND PRACTICE OF CLINICAL RESEARCH (IPPCR) COURSE

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0698). Do not return the completed form to this address.

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Complete the form below and click the Register button at the bottom of the page.

Note: Remote site participant registration is open only to individuals who are affiliated with an approved remote site. If your remote site is NOT listed in the drop down menu, please visit http://cc.nih.gov/training/training/ippcr/application.html for instructions on submitting a remote site request.

Organization

Participant Information

Please list your name as you would like it to appear on your certificate: