Bronchiectasis and NTM Association: Project Proposal Review Form
Name
*
First Name
Last Name
Institution
*
Email
*
example@example.com
Project Information
Proposed Project Name
*
Proposed Project Output (select all that apply)
*
Publication
Preliminary research/information gathering
Patient recruitment (e.g., clinical trials or research studies)
Other, please specify
Publication type (select all that apply)
*
Abstract
Manuscript
Other, please specify
Abstract: Specify Conference
*
Publication: Background
*
Publication: Hypothesis
*
Publication: Specific Aims
*
Patient Recruitment: Specify Enrollment Goal
*
Patient Recruitment: Specify Inclusion/Exclusion Criteria
*
Sponsor and Timeline
Is there a sponsor involved with this project?
*
Yes
No
If yes, please specify.
*
Please indicate the timeline for this request:
*
To complete and submit form you must click "review" button below. Once answers are reviewed, please click "submit" at the bottom of the form to complete.
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