Delegates Please complete the following details and return the registration form to confirm your participation for the 20th Clinical Trials Strategic Summit (CTSS). Upon receipt of this signed form, a formal notification of your VIP slot will be shared with you & with the rest of your industrial peers coming to the event. Prior to the event, complete list of 20th CTSS attendees along with their company & personal lnformation will be shared, so that you can decide your meeting partners according to your preference. Package lncludes:TitleSelected TitleDrProfBothNonePersonal DetailsName *Position *Company Email Address *Personal Email AddressCompany *AddressCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweFaxTelephone *Mobile *The 20th Edition of CTSS aims to ensure quality gathering and knowledge to its attendees, to make it happen we will need you to fill out the following particulars. Your responses will then be used to mature the agenda, as well as corresponding your needs to our supplier's services.1. What are your key priorities for the next 6 to 18 months?Key priorities for the next 6 to 18 months?2. Please list any subjects or areas of interest that you would like to see on the summit agenda:Please list any subjects or areas of interest that you would like to see on the summit agenda.3. What is your Focused Therapeutic Area?What is your Focused Therapeutic Area?4. When does your clinical trials start?When does your clinical trials start?Selected Industrial sector6. Please select your Industrial sector:SelectedPharmaceuticalsSelectedBiotechnologySelectedOtherPersonal budget for Clinical Trials related products & services7. Annual personal budget for Clinical Trials related products & services:Selected< 1 Million USDSelected1-10 Million USDSelected10-50 Million USDSelected> 50 Million USDScope of responsibility8. Scope of responsibility:SelectedDepartmentalSelectedRegionalSelectedEuropeanSelectedInternationalSelectedNationalSelectedOther (Please Specify)Scope of responsibilityProducts & services are you planning to purchase in the next 6-18 months9. What products & services are you planning to purchase in the next 6-18 months?SelectedCentral Laboratory ServicesSelectedMedical Writing & TranslationSelectedClinical Data & Project ManagementSelectedDecentralized TrialsSelectedClinical Trials OperationsSelectedElectronic Data CaptureSelectedDigital Imaging Technology | ToolsSelectedSite Operations SoftwaresSelectedClinical MonitoringSelectedClinical Trial AuditsSelectedPatient ConciergesSelectedBiometricsSelectedClinical Trials Statistical AnalysisSelectedCTMSSelectedFunctional Service ProviderSelectedSite Management ServicesSelectedPatient Recruitment & RetentionSelectedOther (Please specify)Please SpecifyIT services10. Are there any IT-related services you are planning to outsource in the next 6 months? *SelectedWeb DevelopmentSelectedApp DevelopmentSelectedCloud ComputingSelectedSEO (Search Engine Optimization)SelectedDatabase ManagementSelectedIT Consultation (General IT Services)SelectedData Management and AnalyticsSelectedSupply Chain ManagementSelectedCustom Software DevelopmentSelectedEnterprise Resource Planning (ERP)Confirmation CallPlease select a preferred date and time for a brief Discussion Regarding Summit Layout..Hours-120102030405060708091011Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859AMPMDateDateSignature *Start signing your signature hereYour browser does not support e-Signature field.Terms & Conditions;We offer maximum support to each participant for the smooth and efficient proceedings of the summit. However, unfavorable situations may occur, and participants may withdraw participation at the last moment. It disrupts the overall synchronization of the event and creates problems for the rest of the attendees. We kindly request your attention to the following terms and conditions;• The attendees must coordinate regularly and ensure exclusive cooperation• Cancellation must be done 45 days before the event in case of unexpected circumstances• Suitable replacement must be provided in that instance• If no replacement is arranged, a fee of $450 must be paid• Any changes to the schedule will be communicated through written notification• Any issue arising must be resolved through negotiationsSubmit
