AWARE for All is an educational program that is free and open to the public for the purpose of providing education to help people make informed decisions about clinical research participation.

Triangle

Saturday, September 25, 2010
10:00am-2:00pm
North Carolina Central University
H.M. Michaux School of Education Building
1801 Fayetteville St.
Durham NC 27707

Registration for AWARE for All Triangle 2010 is now open. Please complete the form below, or call 617-725-2750.

Fields marked * are required.

First Name *

 

Last Name *

 

Organization Name (if applicable)

 

Street Address (Line 1) *

 

Street Address (Line 2)

 

City *

 

State *

 

Zip Code *

 

Email Address *

 

Phone Number *

 

(Check one box) *

Public or Patient Clinical Research Professional Health Professional Media Other

 

If other, please specify

 

Are you *

Attending the program Planning team or honorary committee Speaking Staffing a tabletop exhibit Staffing a health screening

 

Have you ever participated in a clinical trial? *

Yes No

 

Where did you hear about AWARE for All? (check all that apply)

Facebook Bus or Train Poster Newspaper or Magazine Ad CISCRP email Brochure in the mail Friend or Relative Hospital Newsletter Saw Brochure/Poster in office/health center/hospital/other location From an organization that I belong to Web Site Other

 

If other, please specify:

 

Why do you want to attend AWARE for All? (check all that apply)

To learn more about clinical research I have a health problem/I have a friend or relative that has a health problem I am thinking about being part of a trial For the free health screenings For the food To find out where to sign up for a clinical trial