2019 Workshops Application

PPCR 2019 July Workshops
Welcome to the Principles and Practice of Clinical Research 2019 July Workshops application. Only submit this form if you want to apply for the July 2019 workshops held in Boston, MA. If you would like more information before applying or have questions about this application, please contact us at 2019coordinator@ppcr.org.
*Please complete all fields using standard format of capital letters at the beginning of words and lower case for remaining
Personal Information
First Name (*)
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Middle Name
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Last Name (*)
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Full name as it appears on your passport
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Preferred First Name (*)
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Country of Citizenship (*)
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Street Address (max. 60 characters) (*)
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City (*)
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Country
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State
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Zip Code
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Phone Number (Numbers only, no symbols please) (*)
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Email Address (*)
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Re-enter your email address (*)
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What is your date of birth (DD-MMM-YYYY)
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Highest Degree (*)
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University of Highest Degree (*)
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Year of Graduation (*)
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Current Position (*)
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Current Institution (*)
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Specialty (*)
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What year did you take PPCR? (*)
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Tuition for PPCR 2019 Workshops: 3-day Statistical Workshop: "PPCR Participants, TA, Alumni: - $1,500." , "Non-PPCR Participants: - $2,500." - 2 Day Proposal Writing Workshop: "PPCR Participants, TA, Alumni: - $750" , "Non-PPCR Participants: - $1,500"
Select each workshop you are applying for. (*)

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Workshop Component Refunds: Substitutions may be made without additional charge. All requests for substitutions or cancellations must be made in writing. Cancellations on or before Monday, June 10, 2019 will be issued a refund less a $150 administrative fee per person. Cancellations received between Tuesday, June 11, 2019 and Monday, July 8, 2019 will be issued a refund of 50%. After Monday, July 8, 2019, no refund will be issued. There will be no exceptions to this policy.

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