PREDICT-Meso Network Application

"*" indicates required fields

Title*

Full Name*

Email*

Tick here if you DO NOT want your email contact published on the website

Institute*

Job Title*

Interests/text/synopsis for website:*

Link to home page if happy to have this published on website:

Permission to use photo from homepage/profile

Yes

PREDICT-Meso Pledge:*

I have read the privacy notice and understood how my personal data will be used and agree to this

Types of tissue/samples/data held that may benefit network (eg. Tumour, pleural fluid, blood, DNA, cell lines, mouse model, other)

Human or Mouse

Type/format

Number

Patient group or experiment details/notes (anonymised/de-identified general info only)

Types of data/images held that may benefit network (eg. omics, results data, CTs, MRIs, other)

Human or Mouse

Type/format

Number

Patient group or experiment details/notes (anonymised/de-identified general info only)

I have read and agree to the Membership terms and conditions*

I agree

This can be found on the network page here

This field is for validation purposes and should be left unchanged.