| Page 32 | SIREN

2022 CTMC Registration & Travel Form

Traveler Legal Name

Preferred Name

Sex

Female

Male

Not specified

Title

Date of Birth

Institution

City

State

Zip Code

E-mail Address

Phone Number

Alternate Phone Number

Emergency Contact

NIH Employee

Yes

No

Course Participation

Faculty

Trainee

Airfare Needed?

Yes

No

Travel Date TO Cedar Rapids

Month

Day

Year

Travel Date FROM Cedar Rapids

Month

Day

Year

Travel FROM City or Airport Code

Airline TO Destination, flight number, departure and arrival time

Airline FROM Destination, flight number, departure, and arrival time

Frequent Flyer Number

Please note any special travel or dietary needs

Admin Use ONLY - Flight Confirmation Number

Admin Use ONLY - Flight Cost

Admin Use ONLY - PCard User

1 Start 2 Complete

Leave this field blank

Clinical Standardization Guidelines

Google Doc

PDF available upon request

WebDCU User Manual

WebDCU User Manual - Version 9 (Updated 10/10/2023)

Manual of Procedures

Manual of Procedures (Google Doc) - subject to updates

If you require a PDF version of the protocol please navigate to the google doc and select 'file' > 'download' > 'PDF'. If you are unable to access google docs please reach out to PICECAP-contact@umich.edu.

2022 CTMC Registration & Travel Form

Clinical Standardization Guidelines

Clinical Standardization Guidelines

WebDCU User Manual

Manual of Procedures

Protocol

2022 Investigator Meeting

2022 P-ICECAP Investigator Meeting

Jump To:

Presentations

Outcomes Training

Map

Trial Specific Training