Form 1 Registration

2021 Spring ETCTN (Experimental Therapeutics Clinical Trial Network) Portfolio Presentation/IDSC (Investigational Drug Steering Committee) Meeting

OMB No.: 0925-0740

Expiration Date: 07/31/2022

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.

Fill out the information below, then click Next to proceed. If you experience any difficulties when registering for the meeting, please contact Julia Poms [email protected] or Michelle

Watson: m [email protected] for assistance.

Personal Information

First Name:

Last Name:

Email Address:

Assistant Email:

Degree:

*Affiliation/Institute:

*Job Title:

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Contact Information

Work Address:

*Address:

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Pursuant to the Americans with Disabilities Act, do you require specific aids or services?

Will you be attending the March 26, 2020 dinner?

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