Delegates Please complete the following details and return the registration form to confirm your participation for the 19th Clinical Trials Strategic Summit (CTSS). Upon receipt of this signed form, a formal notification of your VIP slot will be shared with you & with the rest of your industrial peers coming to the event. Prior to the event, complete list of 19th CTSS attendees along with their company & personal lnformation will be shared, so that you can decide your meeting partners according to your preference. Package lncludes:TitleSelected TitleDrProfBothNonePersonal DetailsName *Position *Company Email Address *Company *AddressCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan 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 IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweFaxTelephone *Mobile *The 19th Edition of CTSS aims to ensure quality gathering and knowledge to its attendees, to make it happen we will need you to fill out the following particulars. Your responses will then be used to mature the agenda, as well as corresponding your needs to our supplier's services.1. Who would attend as your replacement if you are unable to make to summit?NamePositionTelephoneCompany2. Who, besides yourself have control over the Clinical Trials related budget?NamePosition3. What are your key priorities for the next 6 to 18 months?Key priorities for the next 6 to 18 months?4. Please list any subjects or areas of interest that you would like to see on the summit agenda:Please list any subjects or areas of interest that you would like to see on the summit agenda.5. What is your Focused Therapeutic Area?What is your Focused Therapeutic Area?6. In which the Therapeutic area is your company active?7. When does your clinical trials start?In which the Therapeutic area is your company active?When does your clinical trials start?Selected Industrial sector6. Please select your Industrial sector:SelectedPharmaceuticalsSelectedBiotechnologySelectedOtherPersonal budget for Clinical Trials related products & services7. Annual personal budget for Clinical Trials related products & services:Selected< 1 Million USDSelected1-10 Million USDSelected10-50 Million USDSelected> 50 Million USDScope of responsibility8. Scope of responsibility:SelectedDepartmentalSelectedRegionalSelectedEuropeanSelectedInternationalSelectedNationalSelectedOther (Please Specify)Scope of responsibilityProducts & services are you planning to purchase in the next 6-18 months9. What products & services are you planning to purchase in the next 6-18 months?SelectedCentral Laboratory ServicesSelectedMedical Writing & TranslationSelectedClinical Data & Project ManagementSelectedDecentralized TrialsSelectedClinical Trials OperationsSelectedElectronic Data CaptureSelectedDigital Imaging Technology | ToolsSelectedSite Operations SoftwaresSelectedClinical MonitoringSelectedClinical Trial AuditsSelectedPatient ConciergesSelectedBiometricsSelectedClinical Trials Statistical AnalysisSelectedCTMSSelectedFunctional Service ProviderSelectedSite Management ServicesSelectedPatient Recruitment & RetentionSelectedClinical planning & supportSelectedCROSelectedRWESelectedClinical Trials Big Data SolutionsSelectedPharmacovigilance & Regulatory AffairsSelectedClinical Trials Budget Management & ForecastingSelectedTele HealthSelectedHEORSelectedeCOASelectedPharmacovigilance & Regulatory AffairsSelectedPV & RASelectedeclinical CLoud/ PlatfromsSelectedImaging ToolsSelectedCTMSSelectedeSourceSelectedDrug Safety SolutionIT services10. Are there any IT-related services you are planning to outsource in the next 6 months? *SelectedWeb DevelopmentSelectedApp DevelopmentSelectedCloud ComputingSelectedSEO (Search Engine Optimization)SelectedDatabase ManagementSelectedIT Consultation (General IT Services)SelectedData Management and AnalyticsSelectedSupply Chain ManagementSelectedCustom Software DevelopmentSelectedEnterprise Resource Planning (ERP)IT servicesPlease select a preferred date and time for a brief consultation regarding IT services.HoursMinutesAMPMDateShort Details Regarding selected servicesDateSignature *Start signing your signature hereYour browser does not support e-Signature field.Important Note Dear Reader,As we gear up for an enriching and collaborative summit, we kindly request your attention to the terms and conditions outlined below this message. Your participation is of immense value to us, and we want to ensure that our summit serves as an optimal platform for meaningful interactions and future collaborations.Your presence is pivotal, and we wish to avoid any inconvenience or last-minute disruptions.That is why, we urge you to carefully review your schedule before confirming your attendance. We recognize the importance of your time and commitment, and our intention is to create an environment that respects and facilitates the contributions and expectations of everyone who is attending. In the unlikely event of an unforeseen emergency, please be assured that we are here to support you. Any associated charges mentioned in the terms and conditions can be waived off under such circumstances. Should you have any concerns or queries regarding the terms and conditions, please feel free to reach out to us. We value your collaboration and look forward to your affirmative response, which will undoubtedly enhance the overall success of our summit.Thank you for considering this request, and we appreciate your continued support.Warm regards,Team Agile Falcon Strategic Group. Terms & Conditions;In consideration of the complimentary pass for the upcoming summit, we kindly request your attention to the associated terms and conditions. Should circumstances necessitate cancellation, we ask for written notification at least 45 days before the event. Additionally, we encourage the designation of a replacement delegate to ensure the continuity of participation. Submit