Search this Section

Health Professional - Membership Form

Title
Name

First

Last
Job Title
Address

Address Line 1

Address Line 2

City

County

Postcode

Country
NHS Trust/Hospital you work for (if you've provided your home address above)
Phone
Email
Secretary's Name
Secretary's Phone
Level of interest
How involved would you like to be?
Help with recruitment of patients to trials
YesNo
Keep me informed of UK DCTN activities (you will receive a news update via email each month)
YesNo
Support developing trials and promote the Network in my area
YesNo
If you would like to be involved in trial recruitment, please list below the hospitals/ centres in your area which you would be able to cover
Area of interest/specialism: Please state the skin conditions you have particular interest in.
Clinical Trials Experience: Please tell us what experience you may have in developing and/or participating in clinical trials.

UK Dermatology Clinical Trials Network

Applied Health Services Research (building 42)
University Park Campus University of Nottingham,
Nottingham
NG7 2RD, UK