注册 名 *姓 *电话号码电⼦邮件地址 *在英国的住址公寓、套房等城市县级邮政编号国家AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe性别 *男性⼥性出⽣⽇期 *身⾼ *体重 *是否吸烟 ?否是患病史⽆是请在此列举您过去曾患疾病及外伤。你有没有在其他临床机构注册? *否是如果您在此选择‘是’,请写下您所注册机构名称。过去有⽆参加过 临床试验 *⽆有你是怎样认识本公司的? *Google SearchFacebookInstagramNewspaper (报章)A Friend (朋友介绍)Event (活动)Content Creator(创作者)其他推荐人名称及注册电邮请注明你曾经参与的活动及地点请注明你曾经参与的活动及地点请注明请注明如果您过去曾参加过临床试验,请写明试验地点和时间。时间 】 例如 20xx 年 3⽉ 【 地点 】 例如: LBO 伦敦本⼈在此提交个⼈信息并同意如上所述。 *本⼈在此提交个⼈信息并同意如上所述。By registering your interest with Chinese Medical Research, You agree for our company to retain your data within our subject / participant database in complete confidence and protected by UK Data Protection Act, General Data Protection Regulation (EU) 2016/679 and all applicable USA / global data protection laws. You are agreeing to Chinese Medical Research using this information to contact you for clinical studies you may eligible for. You are agreeing that your information may be shared with other Clinical Research Units which are conducting clinical studies which you are interested in. You are agreeing that your information can be sent to the Clinical research units in advance of your screening visit, as part of booking you an appointment for study specific medical screening process. The information will be securely stored on the Clinical Research Unit volunteer database in Europe or Non-EU country (e.g. USA) Please note that this data will not be shared with any third party without your permission therefore in order to register you onto our database we require your consent and permission to share your information in confidence, as stated above. We will only share your information with Clinical Research companies / clinics conducting studies which you are wishing to participate in. You may obtain your record or request to delete by writing to us via email or directly via our Chinese Medical Research app if you have downloaded and registered via the Chinese Medical Research app. * 在Chinese Medical Research注册,代表您同意将个⼈信息保存在本公司志愿者数据库中。资料会受英国数据保护法、通⽤数据保护条例 (EU) 2016/679 和所有适⽤的美国/全球数据保护法保护。 您同意Chinese Medical Research使⽤上述信息与您联系,以了解您是否有资格参加临床研究。 您同意当您对某该临床研究有兴趣时,你的信息可能会与该临床研究机构共享。 您同意我们将您的信息发送到临床研究单位,为您预约筛查体检。您的信息会安全地储存在欧洲或⾮欧盟国家(例如美国)的临床研究单位的数据库中。 未经您的许可,我们不会与任何其他第三⽅共享此数据,因此我们需要您的同意和许可,才能记录您的个人信息,并分享与相关机构。 我们只会与您希望参与的临床研究的相关公司、中心或诊所共享您的信息。 您可以通过电⼦邮件向我们查看您在我们数据库中的个人记录,或要求将其删除。登记