Sponsor Information: The sponsoring organization is the entity with primary responsibility for initiating and conducting the trial(s) to be registered.
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Type
of Organization: |
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Country: |
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Organization Name: |
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Organization Address: |
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Organization
Abbreviations and Acronyms: |
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Parent
Organizations, if any: |
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Official
Representative: |
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Phone: |
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Email: |
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Organization
URL (optional): |
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Funding Organization: |
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Administrator Information: The
administrator is the person authorized by the sponsor to update the
information in the Protocol Registration System (PRS) and will serve as
the point of contact for the ClinicalTrials.gov staff. |
Administrator
Name: |
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Affiliation
(if not the sponsor): |
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Administrator
Phone: |
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Administrator
Email: |
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Regulatory Information: The regulatory authority may be a national or international health authority,
an institutional review board or an ethics committee.
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Regulatory Authority: |
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Regulatory Authority Address: |
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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 register@ClinicalTrials.gov.
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