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Membership Registration Form Please complete the following registration form to apply for membership with the Clinical Research CODCRL Network. All fields marked with an asterisk (*) are required.

Membership is free.

* Required field

Name

Username

Password

Confirm Password

Email Address

Personal Information

Gender

Male Female

Date of Birth

Nationality

Contact Number

Address

Professional Information:

Current Institution/Organization

Position / Title

if you select other, please specify your Position/Title here

Medical Specialty

if you select other, please specify your Medical Specialty here

Education and Training

Medical Degree

Year of Graduation

Clinical Research Experience

Number of Years of Clinical Research Experience

Membership Information

Why are you interested in joining the Clinical Research Physician Network?

Are you currently involved in any ongoing clinical research projects? If yes, please provide details.

Thank you for your interest in joining CODCRL Network. We will review your application and contact you regarding the status of your membership.

adress

Mansoura, 60Elgomhoria st, Mansoura University Chlidern Hospital ,

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