Registration

Human Subject Research Core Education: Boot Camp

Date: Friday, December 5, 2014

Time: 8:00am to 4:00pm

Location:  MFRC 3075

 

*Denotes Required Field

*Last Name:
*First Name:
Credentials:
*Email:
*Institution:
*Department:
*Position Title:
*How long have you been on a human research team?
*What is your area of research?
(genetic, observational, drug, device, educational, etc.)
Special Needs?  (dietary, etc.)
Parking Needed? Yes         No
*Phone Number (daytime)
*Payment Type (Pre-payment required)
For Internal Transfer of Funds (MCW only), please complete the following:
Account to be debited:
$75.00 to Office of Research (credit)
Account #45002-471400-103-3304426

A number must be provided: Cost Center; Natural Account; Fund #; non-NIH Grant #; Activity Code (5, 6, 3, 3 digits respectively)
*Name of Dept Administrator or Business Mgr
*Email for Dept Administrator or Business Mgr

For Internal Transfer of Funds:  The Department Administrator or Business Manager will be e-mailed and asked to confirm that payment for this course has been approved. Internal transfers occur from MCW departments.  Remember, a NUMBER MUST be provided as only MCW departments can initiate an internal transfer of funds.

Check payment: Accepted only from outside MCW sources (includes a personal check).  Registration will be complete upon receipt of check.  Send attention to Office of Research, MFRC.

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
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© 2014

Page Updated 12/03/2014
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