Form 1 Registration Form

OMB # 0925-0740 Expiration Date: July 31, 2022 Public reporting burden for this collection of
information is estimated to average 2 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:
(0925-0740). Do not return the completed form to this address.

lnterogency Collaborative Animal Research Education

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Confirmation

This evenc is in test mode.
Please do not use this form for any real registrat ions. The registrations made through the test form will not be valid,

• = required

fiel d

Registration for: ICARE Dialogues

As part of this registration, there are six ICARE Dialogue dates offered. Please choose the date(s) you wish
to participate. Space is limited in each but additional dates may be added if needed

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Creating a password lets you log back in to modify your registration, and speeds up your next
registration.

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For Questions Contact:

Erin Heath, CMP • Event Source Professionals Inc.• O: 972.712.0035 • M: 214.282.6780 • E: erin@espinc·usa.com

OMB # 0925-0740 Expiration Date: July 31, 2022 Public reporting burden for this
collection of information is estimated to average 2 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
(0925-0740). Do not return the completed form to this address.

OMB # 0925-0740 Expiration Date: July 31, 2022 Public reporting
burden for this collection of information is estimated to average 2
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 (0925-0740). Do not return
the completed form to this address.

Dates TBD

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Agenda

Additional People

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Conf i rmation

Since-your evem is currently in *draft'" mode, emails will only be sent to the email addresses of users in your account. This is to prevent
emails accidentally betng sent to invalid "test" ema ils often used when testing registrations such as •[email protected]".
Once your event is live, this restrictio n is lifted and email s will be sent to all email addresses.

Thanks For Registering
We look forward to seeing you at the event.

@' MODIFY REGISTRATION

Registrant Details
Full Name

Email Address

Institution/Organ ization

iii ADD TO CALENDAR

Ms. Erin Heath CMP [email protected] Event Source Professi onals Inc.

ICARE Dialogue Sessions
Selection

Quantity

Ms. Erin Heath CMP
ICARE Dia logue

Date TBD

1

ICARE Dialogue

Date TBD

1

ICARE Dia logue

Date TBD

1

All Sessions are held at 1 PM• 3 PM Eastern Time (12 PM - 2 PM Central, 11 AM• 1
PM Mountai n, 1O AM• 12 PM Pacific).
If you choose "ADD TO CALENDAR", the calendar file will d efault to your timezone set
on your devic e through which you registered.
For Questions Contact:
Eri n Heath, CMP • Event Source Profc ssion a1s Inc.• O: 972.712.0035 • M: 214.282.6780 • E: e [email protected]·usa .com
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The /CARE craining programs are svpponcd by rhc /CARE Projecr, on inreragency iniriativc of the NIH Office of laboratoryAnimal 1Nelfare

From:
To:
Subject:
Date:

Erin Heath, ESP for ICARE Programs
[email protected]
ICARE Dialogues 2020 - Virtual Registration Confirmation
Tuesday, June 30, 2020 3:18:04 PM

Thank you for registering for ICARE Dialogues 2020 - Virtual
Name: Erin Heath
XcelEvents
Confirmation #: 4893610
Your application has been received and is being reviewed. You will be sent an email
confirmation within 2 days.
You registered for the following ICARE Dialogue session(s):
ICARE Dialogue XXXX, 2020, 1 PM - 3 PM EST, ICARE Dialogue XXXX, 2020, 1 PM - 3
PM EST, ICARE Dialogue XXXX, 2020, 1 PM - 3 PM EST
All Sessions are held at 1 PM - 3 PM Eastern Time (12 PM - 2 PM Central, 11 AM - 1 PM
Mountain, 10 AM - 12 PM Pacific).
All sessions will include Closed Captioning.
On your registration confirmation page, if you chose "ADD TO CALENDAR", the calendar
file will default to your time zone set on your device through which you registered. If you did
not do this, you can click on your registration link below and choose "Add to Calendar":
Click here to review or update your registration
We look forward to seeing you at the event!
Thank you,
Erin Heath
Event Source Professionals Inc. for ICARE Dialogues
[email protected]

ICARE DIALOGUES REGISTRATIO

Registration Status
Confirmed
Not Confirmed
Approval Status
Approved
Not approved
Email address
Open field
Prefix
Dr.
Mrs.
Ms.
Mr.

First Name
Open field
Last Name
Open field
Organization Name
Open field
Work Phone
Open field

Gender
Female
Male
Transgender
Choose not to answer

Education
PhD
MD/DO
DVM
JD

MA/MS
BA/BS
AA
Other (open field)
Age Range
18‐33 years
34‐48 years
49‐64 years
65 years and above
Prefer not to say

Race
Native American or Alaska Native
Black/African American
Native Hawaiian or Other Pacific Islander
Asian
White
Prefer not to say
IACUC Member
Yes
No
Role
IACUC (e.g., chair, member, director, administrator, staff, ad hoc)
Compliance, PAM, training
Animal Care and use operations (e.g., clinical vet, facility management te
Animal program administration (e.g., IO, dean)
Years of Experience in Role
1 year ‐ 3 years
4 years ‐ 7 years
8 years ‐ 11 years
12 years ‐ 15 years
16+ years
Type of Institution
Academic
Research
For profit
Government
Non profit
Other [open field]
Oversight Agency(s) (Check all that apply)

USDA
PHS/OLAW
VA
NSF
FDA
DoD
NASA
BARDA
I don’t know
Type(S) of Research 
your IACUC Oversees 
(Check all that apply)
Agriculture
Biomedical
Biosecurity/high risk/BSL‐3 or BSL‐4
GLP (Good Laboratory Practice, FDA)
Toxicology
Wildlife
Other (open field)
I don't know

Registrant ID
Consent
By registering for the ICARE Dialogues, you consent to authorize Event Source Professionals, Inc. (E
to collect your contact and other demographic information for information purposes and that you
to contact you via email, mail or phone regarding the ICARE Program.
Consent is required for your registration for the ICARE Dialogues.

OMB # 0925-0740 Expiration Date: July 31, 2022 Public reporting burden for this collection of information is estimated to average 3 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 (0925-0740). Do not return the completed form to this address.