Join Our Investigator Network
Are you an ABC Member?
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Do you want to be contacted to participate in clinical trials?
If Clinical Trial Training was provided, would you participate in clinical research?
First Name
Middle Initial
Last Name
Suffix (check all that apply)
MD DO DPM PA PhD Other
Other
Specialty
Cardiology Family Medicine Internal Medicine Other
Practice Type
Solo Group HMO Hospital Owned Other
Address
Address Line 2
City
State
Zip Code
Office Phone
Cell Phone
Email
Fax
Research Coordinator Name
Phone
What Type of Trials are you Interested In?(check all that apply)
Hypertension Diabetes CHF Dyslipidemia CAD/ACS Arrhythmia Basic Science Other (specify)
Which of the Following Best Indicate Your Research Interests?(check all that apply)
Basic Clinical Translational CER Other (specify)
Thank-you for completing this form
Optional - Download a PDF of this form and return it via Email, Mail, or Fax.Email: aburroughs@abcardio.orgMail: ABC Inc., 122 East 42nd Street 18th FloorNew York, NY 10168-1898Fax: (202) 375-6801
If you are interested in participating in the Association of Black Cardiologists’ (ABC) Investigator Network, please complete and submit the form below. A representative from the ABC will follow-up with you. Projects may vary from a quick survey or questionnaire to more involved controlled trials.