Palliative Care Clinical Studies PaCCSC Membership Application

* indicates mandatory fields

About you

Title*
Country/state*
Location*

Employment and qualifications

Please enter the full name of your organisation.

Occupation*

e.g. palliative care

e.g. oncology

Do you undertake research as part of your role?*

Membership

Membership level?*

Please indicate which membership level you are applying for:

Are you a member of any other Cancer Cooperative Trials group, or other clinical group?*

Interest

Please indicate which of the following research areas you are interested in. Tick all that apply.

Population*
Symptoms*
Conditions*

Nominators

Please provide the name of two current PaCCSC members who support your application.

Declaration

I agree to my information being saved in a confidential database to be used by Palliative Care Clinical Studies Collaborative to: contact me about research opportunities within PaCCSC; send me newsletters; invite me to events.

 
Acknowledgement of Country

UTS acknowledges the Gadigal people of the Eora Nation, the Boorooberongal people of the Dharug Nation, the Bidiagal people and the Gamaygal people, upon whose ancestral lands our university stands. We would also like to pay respect to the Elders both past and present, acknowledging them as the traditional custodians of knowledge for these lands.