Clinical Trial Investigator Registration
PPD, Inc. and its affiliates will use the information you provide on this page for the purpose of setting up your online investigator profile. You will be asked for further details as you move through the registration process that will allow PPD to consider you for future investigator opportunities. Important information on how PPD handles personal information and what rights you may have under data privacy laws are included within PPD’s
Global Privacy Policy
.
Please note that the account must be set up solely by the investigator. The same applies to completing the investigator background information (IBI) form and the data protection authorization (DPA) forms. If you are a study coordinator or someone else involved in conducting trials with the investigator, you may request copies of the PDF version of the IBI and DPA by emailing
PPD
, filling out the forms and asking the investigator to sign them. You can then either fax or mail the forms to us. The fax number and mailing address are on the document.
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REQUIRED FIELDS
Login Information
Login Information
Email:
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This will be your user ID when you log in.
Confirm Email:
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Password:
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Password must be at least 8 characters long, includes both numbers and letters (at least one in uppercase and one in lowercase), and one of this special characters ( _ ! - # $ & *).
Confirm Password:
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Security Question #1: *
Security Question #1:
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Please select one ...
Favorite hobby/sport?
City of birth?
Favorite color?
City of first job?
Color of first car?
Childhood hero?
Answer for Security Question #1:*
Answer for Security Question #1:
*
Security Question #2: *
Security Question #2:
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Please select one ...
Favorite hobby/sport?
City of birth?
Favorite color?
City of first job?
Color of first car?
Childhood hero?
Answer for Security Question #2:*
Answer for Security Question #2:
*
Profile Information:
Profile Information:
First Name:*
First Name:
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First Name:
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Middle Initial:
Middle Initial:
Middle Initial:
Last Name:*
Last Name:
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Last Name:
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Job Title:*
Job Title:
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Job Title:
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Language Preference: *
Language Preference:
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Please select one ...
Afrikaans
Arabic
Armenian
Bahasa Indonesia
Bahasa Melayu (Malay)
Bangla
Belorussian
Bengali
Burmese
Cantonese
Chichewa
Chinese (Mandarin)
Croatian
Czech
Danish
Dutch
English
Estonian
Farsi
Filipino
Finnish
Flemish
French
French-Canadian
German
Greek
Guarani
Hebrew
Hindi
Hungarian (Magyar)
Icelandic
IsiXhosa
IsiZulu
Italian
Japanese
Javanese
Korean
Latvian
Lithuanian
Luxembourgish
Maori
Melagasy
Moldovan
Nepali
Norwegian
Persian
Polish
Portuguese
Punjabi
Quechua
Romanian
Russian
Serbian
Serbo-Croatian
siSwati
Slovak
Slovenian
Spanish
Swahili
Swedish
Tagalog
Taiwanese
Thai
Tok Pisin
Turkish
Ukranian
Vietnamese
Gender: *
Gender:
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Please select one ...
Male
Female
Institution: *
Institution:
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Institution:
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Street Address 1: *
Street Address 1:
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Street Address 1:
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Street Address 2:
Street Address 2:
Street Address 2:
City: *
City:
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City:
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State/Province (US/Can Only):
State/Province (US/Can Only):
Please select one ...
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands US
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
State/Province (Outside US/Can):
State/Province (Outside US/Can):
State/Province (Outside USA/Canada):
Zip/Postal Code: *
Zip/Postal Code:
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Zip/Postal Code:
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Country: *
Country:
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Please select one ...
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Congo (Democratic Rep)
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgystan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Phone Number: *
Phone Number:
*
Phone Number:
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Fax Number:
Fax Number:
Fax Number:
Cell Number:
Cell Number:
Cell Number:
Pager Number:
Pager Number:
Pager Number:
Type the code exactly shown to the field below: *
Type the code exactly shown to the field below:
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selected country
selected country
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