Register Your Site

INVESTIGATOR DATABASE INFORMATION FORM U.S. SITES

There is never an ongoing fee for a site to be part of the BRANY alliance or to be presented with opportunities. Please complete and submit the registration form below and we will contact you. For investigators already affiliated with or employed by an existing BRANY alliance member site, please complete the short form provided by the link at the bottom of this page.

Please attach an electronic version of your current CV.

  • Practice Setting

    What is your Practice Setting: (Check all that Apply)

  •  University Based Research Center Solo/Group Practice Hospital Staff Medical School Faculty Urgent Care Center Consortium/Network Rehab Hospital/Clinic Nursing Home/Extended Care Research Center
  • Support Staff

  •  Same As Contact Person
  •  MD Coordinator Other
  • Training

  •  Yes No
  • Acceptable certificates include academic medical center earned CME, Dunn and Chadwick's Protecting Study Volunteers in Research or http://phrp.nihtraining.com/users/login.php

  •  Yes No
  • Certificates are required for IRB approvals.

  • Facilities

  •  Yes No
  •  PI RN Non-RN
  • Equipment

  •  Yes No
  •  Yes No
  •  Yes No
  •  Yes No
  • If Yes, please fax the 483 form to 516-470-6903

  • References

    We will be contacting Sponsors and CRAs you have worked within the past to assess GCP compliance.

    Please list two references

  • Did You Ever Have Any Medical License Issues ie, Suspensions or Probation Period? *

  •  Yes No
  • For investigators who are affiliated with or employed by a BRANY alliance member site, please complete the short form provided at this link click here.