INFORMED CONSENT REGISTRATION

All registration information will be entered into the Committees' database for internal use, and will not be disclosed to third parties. A certification will be automatically sent via e-mail for completion of this educational module.

REGISTRATION

First Name:

Last Name:

Full name (ex. Jerry Smith, MD) as you would like it to appear on your e-mail certificate (include MD, PhD, etc. as appropriate):

Enter your UVM or UVM Medical Center e-mail address. We prefer either a UVM or UVM Medical Center address, however if you do not have a UVM or UVM Medical Center e-mail address you may enter a personal e-mail address. Note: Keep in mind that the certification as well as required human subjects in research updates (if applicable) will be sent to you via this address. So it is important that we have an active email address for you.

E-mail

UVM or UVM Medical Center e-mail address:

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First Name:
Last Name:
Full name (ex. Jerry Smith, MD) as you would like it to appear on your e-mail certificate (include MD, PhD, etc. as appropriate):