Application Form - conect4children

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Collaborative network for european clinical trials for children

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The Project
Network
Academy
- Academy
- External Training Courses
PoV Studies
Patients
- Educational Resources
- Workshops
News
Contact

Advanced Course on paediatric clinical trials & paediatric drug development.

PLEASE COMPLETE THE BELOW FORM TO EXPRESS YOUR INTEREST IN ENROLLING IN THIS COURSE.

First name*

Family Name

Nationality

Country of Residence

Email Address*

Professional Qualification*

MD, Pediatrician

MD, Other speciality

Pharmacist

Chemist

Biologist

Nurse

Other, specify

Specify other speciality:

Are you an employee of an institution?

Yes

No

Which Institution

Are you an employee of a company?

Yes

No

Which company

Is your institution / company a member / 3rd Party of c4c?*

Yes

No

Do not know

Are you working within any c4c activity?*

Yes

No

Which activity / activities

Are you connected to a National Hub?*

Not connected to any National Hub

Austria - OKIDS

Belgium - BPCRN

Czech Republic - CUNI

Denmark - DanPedMed

Estonia - ELAV

Finland - FINPEDMED

France - PEDSTART

Germany - RBMF

Greece - HELPNET

Hungary - MCRN

Ireland - In4kids

Italy - INCIPIT

Netherlands - PEDMED-NL

Norway - NORPEDMED

Poland - POLPEDNET

Portugal - STAND4KIDS

Spain - RECLIP

Sweden - SWEDPEDMED

Switzerland - SwissPedNet

United Kingdom - NIHR-CRN

Have you experience of Clinical Trials?*

Yes

No

Have you ever had a role in paediatric drug related clinical trials? *

No

Yes, 1 only

Yes, 2

Yes, more than 2

What was your role in the trial(s)?

To proceed with the application, please ensure you have read carefully the "Information about the Advanced Course, 2nd Edition"

Pay attention to the interactive activities planned in the course and carefully evaluate the engagement time you need to actively participate in the course.

Please confirm you have read in full the "Information about the Advanced Course, 2nd Edition"

Yes

No

Are you willing to inform your supervisor if you enroll in the course?

Yes

No

Do you think your supervisor will allow you to utilize some of your time to participate in the course?

Yes

No

Considering all the above points, do you think you will be able to actively participate in all the interactive activities of the course? *

Yes

No

In a few words, please tell us why you would like to enrol in this course:*

By clicking submit, you confirm that have read the c4c Privacy Policy and agree that your data included in this application form can be stored by this website and used for the organisation of the c4c Advanced Course.

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PoV Trials Specfic Courses Hub

PoV Trials Specific Courses

This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777389.
The Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA.

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PLEASE NOTE: The c4c project is now closed.

If you want to stay updated, visit the NEW conect4children Stichting (c4c-S) website:

c4c-S Website

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