CWIS CIID Interest Submission Form

The Chest Wall Injury Society welcomes all CWIS members who wish to contribute the Chest Injury International Database. Below please find our request form. We will contact you via the supplied contact information as your request is submitted and again as your date of enrollment approaches. Thank you for your interest.

Questions?
If you have any questions, please email SarahAnn Whitbeck at sarahann@cwisociety.org.

Primary contact first name

First NameLast NameCredentials

Preferred email address for communication

example@example.com

Institution

Administrative contact first name

First NameLast NameCredentials

Administrative email address for communication

example@example.com

Have you established a data repository in the past?

YesNoI don't know

Do you know who would sign a DUA (data use agreement) at your institution?

YesNoI don't know

What level Trauma Center is your institution?

Level ILevel 2Level 3Other

My primary site for SSRF is located:

Approximately how many cases were performed at your institution last year?

1 - 1011 - 2021 - 30Greater than 30

If you have any questions, please contact the
Chest Wall Injury Society via email at information@cwisociety.org.