Form 1 Registration

Conference, Meeting, Workshop, and Poster Session Registration Generic Clearance (OD)

Attachment Registration GISC (1)

GISC Neuroendocrine Tumor Clinical Trials Planning Meeting (NCI

OMB: 0925-0740

Document [docx]
Download: docx | pdf

Shape18 Shape19

2/20/2020

NCI Neuroendocrine Tumor Clinical Trials Planning Meeting - Registration Information | Online Registration by Cvent


NCI Neuroendocrine Tumor Clinical Trials Planning Meeting


Shape1

OMB No.: 0925-0740 Expiration Date: 07/31/2022

Public reporting burden for this collection of information is estimated to average 5 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.


Shape2









Please fill out the form below then click Next to proceed. Please contact Natalie Fielman 240 276-6846 or Michelle Watson 240 276-5256 if you require assistance.


Shape3
Personal Information

First Name:



Last Name:



Email Address:



Shape4
Degree(s):


Shape5
*Affiliation or Institute:


Shape6
*Job Title:


Shape7
CC Email Address:


Work Address:

Shape8
Shape9
Shape10
Address:




Shape11
City:


Shape12
State/Province:


Shape13
ZIP/Postal Code:


Country:


Shape14


Shape15
Work Phone:




Shape16
Shape17 Registration Questions

Special accommodations requests (i.e. hearing, mobility, or transportation needs) for the meeting/hotel must be submitted to Natalie Fielman(Natalie.Fielman@nih.gov) no later than 10 days prior to the conference)

Shape20 Shape21

https://www.cvent.com/Events/Register/InformationPage.aspx?rc=36d70d67-6c14-45f8-bb59-a690fad5d10d

3 /2


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMitchell, Annette (NIH/NCI) [E]
File Modified0000-00-00
File Created2022-02-01

© 2024 OMB.report | Privacy Policy