Urgent Care Research Network

Urgent Care Research Network

Registration Form
Name*

First NameLast Name
Email (work or institution preferred)*
example@example.com
Phone Number (optional)
Where do you work?*
Please indicate which of the following applies to you (select as many as apply)*

FRNZCUCFRNZCGPRNZCUC registrarGPEP registrarFACEMACEM registrarNurse PractitionerRegistered NurseParamedicOverseas DoctorOverseas Nurse PractitionerOverseas NurseOverseas ParamedicPHDPHD candidateUniversity EducatorMedical StudentOther
If you answered overseas or other to the previous question, please elaborate
Are you experienced in any of the following areas?

StatisticsEthicsLiterature reviewsQuantitive studiesQualatitive researchRandomised controlled trialsJournal editingMedical writingPeer ReviewResearch Protocol DevelopmentGrant ApplicationsPrimary investigator
Please describe your research areas of interest
Have you previously been published?*

YesNo
Please list any previous publications, if applicable
Are you currently working on any research? If so, please describe the work
Would you be interested in being a research network committee member?*

YesNo
Would you be interested in being a regional representative for the network?*

YesNo
Do you have any conflicts of interest to declare in relation to joining the network?*

YesNoDon't know
If you answered yes to conflict of interest, please elaborate
If the RNZCUC requires an expert, externally contracted (paid) opinion pertaining to education or research, would you be interested in being contacted to see if you would be interested in offering your expertise/opinion? This is seperate to the urgent care research network but enables the College to access external expertise via the network. There is no guarantee of work*

YesNoDon't know
The information supplied in this registration form will be stored on the College's IT system. Once registrations have been received, a meeting will be arranged to enable formation of a committee, who will then determine the next steps for the network.
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