IASLC International Staging Project Database Account Change Form

IASLC International Staging Project Database Account Change Form

Please use this form to update your account information. The name of the project (Lung Cancer, Mesothelioma, and Thymic Malignancies) and the name of institution are required fields; however, it is not necessary to enter the address or fax number unless this information has changed. Likewise, please enter only the specific users for whom changes are being requested. GCCB-II/GCCB-III membership applies only to institutions located in Spain.
Please indicate the project in which you are participating. If you are participating in multiple staging projects, please submit a separate form for each disease site.
Institution Information
Who is submitting this form?

TitleFull NameEmail Address
Site number (if known)
Institution Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Member of GCCB-II or GCCB-III Consortium?

YesNo
Data Entry System Users

Please note that only the Principal Investigator (or the established designate for the PI) another previously authorized user can make changes to the account.
User ID (if known)
Name

TitleFirst NameLast Name
Email Address
Please make the following change to the above listed account:

Add new accountUpdate contact informationDe-active existing accountDesignate this user as the Principal Investigator
User ID (if known)
Name

TitleFirst NameLast Name
Email Address
Please make the following change to the above listed account:

Add new accountUpdate contact informationDe-active existing accountDesignate this user as the Principal Investigator
User ID (if known)
Name

TitleFirst NameLast Name
Email Address
Please make the following change to the above listed account:

Add new accountUpdate contact informationDe-active existing accountDesignate this user as the Principal Investigator
User ID (if known)
Name

TitleFirst NameLast Name
Email Address
Please make the following change to the above listed account:

Add new accountUpdate contact informationDe-active existing accountDesignate this user as the Principal Investigator
User ID (if known)
Name

TitleFirst NameLast Name
Email Address
Please make the following change to the above listed account:

Add new accountUpdate contact informationDe-active existing accountDesignate this user as the Principal Investigator
User ID (if known)
Name

TitleFirst NameLast Name
Email Address
Please make the following change to the above listed account:

Add new accountUpdate contact informationDe-active existing accountDesignate this user as the Principal Investigator
Should be Empty:

IASLC International Staging Project Database Account Change Form

Institution Information

Data Entry System Users