MEMBERSHIP REGISTRATION FORM

MEMBERSHIP REGISTRATION FORM
Dear Colleagues
I would like to invite you to join the Innovative Oncology Network (ION) to receive the latest updates in oncology and explore potential opportunities for collaboration in research and clinical care programs.

Innovative Oncology Network (ION) Membership Team
*

Yes- I would like to sign up
Full Name *

First Name Last Name
Degrees *

MD MPH PhD RN Pharmacist Pharm D
Profession *
Profession - if others please specify *
Specialty *
Specialty -Others *
E-mail *
Mobile Number *

country Code Mobile Number
Country *
City *
Name of institution/ Affiliation *
Area of Clinical interest *

Breast Cancer Lung Cancer GI Cancers GU Cancers Sarcoma /Melanoma Gynecologic Cancers Neuro-Oncology Head & Neck Cancer Hematologic Malignancies Other
Area of Reserch interest *

Breast Cancer Lung Cancer GI Cancers GU Cancers Sarcoma /Melanoma Gynecologic Cancers Neuro-Oncology Head & Neck Cancer Hematologic Malignancies Other
Please specify the Other Research field interest
Are you eligible to be a principal investigator at your institution? *

Yes No
Have you participated in conducting clinical trials/ cancer research? *

Yes No
Plesae select the phases of cancer clinical trials/ cancer clinical research which you have experinace in ? *

Basic science Phase 1 Phase 2 Phase 3 Phase 4 Phase 4 B Epidemiology studies Qualitative research Quantitative research
Research portfolio/ profile [Researchgate, Google Scholar Scopus, Etc..]
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