Join SCRS – Member Employee - Society for Clinical Research Sites – SCRS
Join SCRS – Member Employee

Join SCRS – Member Employee

Thank you for your registering as an employee of an SCRS member. Please complete the form below to tell us a little about yourself. Please allow 24 hours for your account to be processed and activated. We will notify you by email when your application has been accepted.

If your company has NOT already been registered, please click here to register your company.

NOTE: * indicates required field.

Member Employee Information

Company Name*

Company Membership #*

First Name*

Last Name*

Business Address*

Suite or Unit #



Zip/Postal Code*



Phone Ext.

Mobile Phone

Home Phone

Work Email*

Alternate Email

Facebook URL

Linkedin URL

Twitter URL

Highest Education Completed?

Current Certifications
  Fellow of American Academy of Family Physicians (FALP)
  Fellow of American Psychiatric Association (FAMA)
  Fellow of the American Psychiatric Association (FAPA)
  Fellow of Academy of Psychosomatic Medicine (FAPM)
  Fellow, Faculty of Pharma Medicine (FFDM)
  Fellow, International Society for Pharmacoepidemio (FISPE)
  Fellow of the Royal College Physicians (FRCP)
  Juris Doctor, Doctor of Law (JD)
  Licensed Practical Nurse (LPN)
  Masters of Art (MA)
  Masters of Business Administration (MBA)
  Master in Library Information (MLIS)
  Masters of Science (MS)
  Doctor of Naturopathy (ND)
  Nurse Practitioner (NP)
  Doctor of Optometry (OD)
  Physician's Assistant (PA)
  Doctor of Pharmacy (PharmD)
  Doctor of Philosophy (PhD)
  Project Management Professional (PMP)
  Regulatory Affairs Certification (RAC)
  Registered Dental Hygienist (RDH)
  Registered Dietitian (RDH)
  Registered Nurse (RN)

Are You Interested In Serving On A Committee?
  Yes   No

Committee Interest
  Public Policy
  Global Site Solutions Summit
  European Site Solutions Summit
  Asia-Pac Site Solutions Summit
  Oncology Site Solutions Summit


Notes or Questions