JHU ICTR

Investigator Information Registration Form

The Johns Hopkins Clinical Research Network (JHCRN) invites investigators to submit basic information to be included in a directory to match clinical research opportunities with appropriate investigators within the Johns Hopkins Medicine, Suburban, Sibley, Howard General, and JHCRN affiliated institutions. Affiliate institutions currently include Anne Arundel Medical Center (AAMC), Greater Baltimore Medical Center (GBMC), Inova Health System, Peninsula Regional Medical Center (PRMC) and Reading Hospital System (RHS).

When a research study opportunity is presented to the JHCRN, the JHCRN will search for investigators whose research interests and specialty match a given criteria. This information is solely used for the purposes of matching investigators with appropriate research studies. By providing this information, the investigator agrees to be contacted about potential research studies.
First Name: * Last Name: *
Highest Degree: *
Address: *    Phone Number:
(Optional)
E-mail: *
Primary Institution Affiliation: *
In regards to being a Hopkins Faculty Member, you are: * Full-time Part-time neither
Primary Specialty: *
Secondary Specialty:
(Optional)
Research Area(s) of Interest: *   
Research Support Staff Member Contact Information (Optinal)
Staff First Name: Last Name:
Email: Phone:
Keyword/Comment:
(Optional)
  
  Are you interested in participating in a JHCRN disease-specific working group? *
Yes No
  The JHCRN intends to share your information with external research entities (i.e. pharmaceutical sponsors and/or their associates) when a potential opportunity matches your specialty area(s) and/or research interests. *

You agree to allow the JHCRN to share your information with entities external to JHCRN sites.
Yes No

Please enter text in image: *