Personal Data
First name/names:
Last name:
Address:
Postal Code:
City:
Country:
Phone:
Mobile phone:
e-mail
Current position
Company:
Address:
Position:
Education
University:
Department:
Address:
Degree granted:
Graduation Date:
Have you participated in any courses/trainings in clinical trials?
How many years of experience in clinical trials do you have?
Costs covered by:
Source of information:
Pursuant to Act of 29.08.1997 on Personal Data Protection, Statute Journal No 133 item 883 I hereby give permission for processing my personal data for the purposes of this course without the right to distribute.
Rewrite text from the image:
All fields are Obligatory fields