Contact Us PCRP GCP Training Request Form For any GCP training and other training requests, please complete the form and send to Karen Dela Cruz and Maria Rosario Mislang (Scientific Affairs Committee, PCRP) through email: KarenAnnMarieDela.Cruz@iqvia.com and Maria.Mislang@ppd.com Click here to download the form Get In Touch with UsContact us by sending an email to philclinresprof@gmail.com Name Email Phone Message Send Request Form for GCP Training / Workshop Note: This form should be submitted to PCRP at least 8 weeks prior to proposed / requested date of training. Name of Requestor / Coordinator Name of Institution / Medical Society Complete address of Institution: Contact Details: Tel # Mobile # Fax # Email address of Coordinator Date of GCP Training: Training session: 8:00 am – 5 :00 pm Option 1 Option 2 (Please indicate target date/s. Date of training will be confirmed by PCRP Coordinator.) Venue of Training For online, please provide details Objectives / Purpose : (Please check / fill-up with details.) To conduct Basic / Refresher Course GCP Training To comply requirements for GCP / conduct of clinical trial To comply requirements for hospital accreditation To comply requirements for Epidemiology / Research / Residency / Fellowship research paper Other purpose, please specify Target # of attendees: (Please check.) 15 - 20 persons 20 - 25 persons 25 - 30 persons 30 - 35 persons 35 - 40 persons 40 - 50 persons For online, please specify We may need to divide the group into 2 sessions Profile of attendees: (Please check / fill-up with details.) Consultants / Specialists Nurses Residents / Fellows Pharmacists EC / IRB personnel Lab personnel Others, please specify (i.e. particular dept. / therapeutic area Clinical Trial Experience ALL with ongoing/previous participation or experience in Clinical Trials No Clinical Trial experience Mixed (some with CT experience while some none) Requested date of training is subject to approval / availability of PCRP Scientific Affairs Committee / Speakers Bureau. Requesting party is responsible for printing the hand-outs / materials / training certificates for the participants. Requesting party is responsible for the provision of meals (AM / PM snacks / Lunch) for participants / speakers (if applicable) and for other logistical requirements (i.e laptop / LCD projector / laser pointer / whiteboard or flipchart/s with pens, classroom / training room set-up, sound system or online training platform, if online) PCRP requests maximum of 10 slots be made available for attendees from PCRP during the training. Once request is received by PCRP, please allow PCRP to schedule the training in 2-3 months. If your request is urgent, please communicate with Karen Dela Cruz ( karenannmariedela.cruz@iqvia.com ) and Maria Rosario Mislang ( maria.mislang@ppd.com ). PCRP does not charge nor will accept any monetary compensation for speakers engaged in the facilitation of training. Submitted by: Name of Requestor Date (dd / mm / yyyy) Send