Registration

Source
Research groups
- Select All
- Group 4c
First name*
Last name*
Gender*
- Male
- Female
Date of birth*
You must be at least 18 years old at the time of application. We cannot process applications from persons under the age of 18.
E-mail address*
Countrycode*
Phonenumber*
Address information*
Streetname House number City Postal code Country

I am aware that (mandatory tick):*
- I receive a call at the specified number for a telephone intake.
- I will first undergo a medical screening (in Groningen) before the clinical trial.
- I do not smoke more than 20 cigarettes per week.
- The trials in Groningen are (€0.21 p/km fee).
- As a not Dutch citizen, I need a Dutch residence permit. *
* If you are not a Dutch citizen, the same rules apply to participation in drug trials as to any other work. If you are a citizen of a member state of the European Union, Norway, Liechtenstein, Iceland, or Switzerland, you can work freely in the Netherlands and you do not need permits. As a citizen of all other countries, you need a Dutch residence permit from the IND that states: work is freely allowed. A work permit (twv) or combined permit for residence and work (gvva) are not valid for participation.
When do you want to be called by us?
- In the morning
- In the afternoon
- In the evening
We will call you soon to review your application. Please indicate when you are available so we can call you at the right time.
Optional: Notes/Preferences
Permission*
- I agree with the privacy statement. Part of this is that my data is stored and used to process the registration.

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