Update Profile

Please complete the following fields (First Name, Last Name, Current Email address, Country of Residence) as it was originally submitted. Please use this form if you are a qualified Physician who wishes to be considered for participation in AstraZeneca Clinical Trials. Please note that registration does not guarantee participation. If you would like to contact AstraZeneca for any other reason, please use our contact us form.

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AstraZeneca Investigator Registration

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The fields marked with an asterisk are mandatory

Name

Title

First name asterisk

Middle name

Last name asterisk

Primary Location

Primary hospital, institute and/or department

Address

Address Line 2

City

Zip/Postal code

Country of Residence asterisk

Email address given at registration asterisk

Enter new email address

Phone asterisk

Alternative Phone

Fax

Additional Institution Affiliation

Clinical Speciality asterisk

Second Clinical speciality

Research interest

Type of medical facility

Patient Population Demographics (Check all that apply)

Pediatric

Adult

Elderly

Experience of clinical studies

Number of clinical studies (within last five years)

Phases of drug development

Phase I

Phase II

Phase III

Phase IV

I have read and understood the contents of this form and the following Consent Notice. asterisk

By ticking the box you consent to AstraZeneca UK Ltd processing personal information about you (some of which may be sensitive) for the purposes of: a) assessing whether to enter into further agreements with you and/or the organization you represent; b) building a contacts database of health care professionals; and c) complying with any applicable legal and/or regulatory requirements; together known as the 'Uses.' AstraZeneca may share your personal information with its group companies and/or regulatory authorities and/or third party partners or suppliers (who may be located anywhere in the world). AstraZeneca's third party partners' and suppliers' activities will be restricted, under written contract, to the Uses. Nothing in this collection notice affects any other permissions you may have granted, or rights AstraZeneca (or its group companies) may have, in relation your personal information which it processes about you now or in the future.

I certify that I am qualified to practice medicine in my country of residence. asterisk

I understand that completing this form expresses my interest in working with AstraZeneca and does not guarantee participation in AstraZeneca clinical trials. asterisk

I authorize AstraZeneca to use the above information to contact me by telephone SMS fax or email asterisk

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