Individual Account Application
* Username :
* Password :
* Confirm Password :
Sponsor Information The sponsoring organization is the entity with primary responsibility for initiating and conducting the trial(s) to be registered.
* Type of Organization:
* Country:
* Organization Name:
* Organization Address:
Official Representative:
Phone:
* Email:
Organization URL (optional):
Funding Organization:
Investigator Information
* Investigator Name:
Affiliation (if not the sponsor):
* Investigator Phone:
* Investigator Email: *contact e-mail
Regulatory Information : The regulatory authority may be a national or international health authority, an institutional review board or an ethics committee.
Regulatory Authority:
Regulatory Authority Address:
To the best of my knowledge, the above information is true and correct. Questions about this form and the Protocol Registration System (PRS) may be sent to tctr@thaimedresnet.org
  
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