POINT OF CONTACT INFORMATION. If you have a call blocking error complaint or if you would like us to verify the authenticity of the calls of a calling party that is adversely affected by information provided by caller ID authentication, please contact us at: xxxxxxxxxxxx@xxxxxx.xxx. To opt-out of the Call Blocking Feature (which will also opt you out of the Caller ID Alert feature) call 0-000-000-0000.
POINT OF CONTACT INFORMATION. A. The name, address, and telephone number of the Volunteer Florida CERT Program Manager: Xxxxxxx Xxxxx, Emergency Management Deputy Director 0000 Xxxxxxx Xxxxx Road Suite 250 Tallahassee, FL 32308 (000) 000-0000 Xxxxxxx@XxxxxxxxxXxxxxxx.xxx OR Xxxxx Xxxxxxxx, Grants and Contracts Manager 0000 Xxxxxxx Xxxxx Road Suite 250 Tallahassee, FL 32308 (000) 000-0000 Xxxxx@xxxxxxxxxxxxxxxx.xxx
POINT OF CONTACT INFORMATION. For MTSU: Xxxx X. Xxxxxx Advising Manager Pre Professional Health Science Advising Center College of Basic and Applied Sciences MTSU Box 66 (000) 000-0000 xxxxx.xxxxxx@xxxx.xxx For South: Dr. Xxxx Xxxxxx, Xxxx South College School of Pharmacy 400 Goody’s Lane Xxxxx 000 Xxxxxxxxx, XX 00000 (000) 000-0000 xxxxxxx@xxxxx.xxx
POINT OF CONTACT INFORMATION. Identify the person who will serve as the project team point of contact for this request. This person is responsible for communicating questions and IRB decisions to project team members at all sites. (The project team Point of Contact could be the Principal Investigator or an individual coordinating the project.) Name: Click or tap here to enter text. Email: Click or tap here to enter text. Phone Click or tap here to enter text. When requesting that Xxxxxxxx rely upon (cede to) another IRB complete the following additional section. Then submit this entire form along with the protocol document* and consent form, if applicable, to xxxxxxxx@xxxxxxxx.xxx. Proposed reviewing IRB information Name of proposed reviewing IRB: Click or tap here to enter text. IRB FWA#: Click or tap here to enter text. Name of IRB contact: Click or tap here to enter text. Email address: Click or tap here to enter text. Phone: Click or tap here to enter text. Funding Information Funds will come to Xxxxxxxx through: ☐ direct award/contract ☐ sub-contract ☐ service agreement ☐ Not funded Local Information Recruitment procedures will be conducted at Xxxxxxxx as outline in the protocol, if applicable: ☐ Yes ☐ No Will you review medical records prior to consent to determine eligibility? ☐ Yes ☐ No If yes, specify source of records (x.x. Xxxxxxx Health, Wake Medical, etc.)? Click or tap here to enter text. Will you require access and use of student records? ☐ Yes ☐ No Will you require the records to be ☐ identified or ☐ de-identified Please specify the source of the records Click or tap here to enter text. Consent process will be conducted at Xxxxxxxx as outline in the protocol? ☐ Yes ☐ No If not included in the protocol or if different than in the protocol, explain the process for this site: Click or tap here to enter text. Activities at local site Briefly describe all study activities to be conducted at Xxxxxxxx: Click or tap here to enter text. *Protocol summaries, narrative or grant applications should include (at minimum) the following sections: Purpose, Aims, Research Design, and Procedures to be conducted at each site.
POINT OF CONTACT INFORMATION. For Xxx University: For UTC: Xxxxxx Xxxxxx Xxx Xxxxxx Vice President of Academic Affairs Director of Undergraduate Admissions xxxxxxxxx@xxxxxxxxxxxxx.xxx Xxx-Xxxxxx@xxx.xxx Phone: 000-000-0000; x8118 Phone: 000-000-0000
POINT OF CONTACT INFORMATION. Contact Full Name: Position/Title: Work Phone Number: _ Cell Phone Number: Business Email Address: Billing Information Contact Name for Invoice Purposes: Billing Address: City: County (if applicable): _ State/Province: ZIP/Postal Code: Country: Accounts Payable Information Contact Name: Phone Number: Business Email Address: Preferred Method of Payment: ☐ACH/EFT ☐Credit Card Completed By: Date: Title: SCHEDULE “C” Product and Pricing Accounting/Billing: ☐ ISB to send one itemized bill at the end of each month payable by Credit Card Credit Card will be charged once the invoice is issued. Credit Card Number Name on Card Expiry Date CVC Payment Terms: The Company shall pay invoice(s) upon receipt. Any invoice outstanding for over 30 days from invoice date will be subject to an interest charge of 15% per year. ISB reserves the right to suspend Services if any account(s) remains outstanding for over 60 days, and to continue such suspension until such account(s) are paid in full. Pricing Conditions: The following preferred pricing is as a result of the client having a business / commercial relationship with e2r. In the event the client terminates their relationship with e2r, the preferred pricing will no longer be applicable and will be subject to renegotiation. The preferred pricing below is applicable for orders place in both the My Order Center and E-Commerce applications. Cancellation fee of $3.00 will be applied to any order that has been placed and no action taken within 3months Manual entry fee of $5.00 per order will apply if ISB Global Services is asked to enter orders manually New MID/MOC platform will require #1603 & #1686 or #1685 or both to complete the order Product Offering/CODE Timing Price Premium National Criminal Record Check - #1603 ISB’s Premium National Criminal Record Check will offer the most comprehensive national criminal background check available in Canada. ISB’s Premium Criminal Record Check includes a search of both the National Repository and the additional searching of local police records to ensure that a potential offence does not go undetected. 1-4 Hours $20.00 MID – Mobile Identity Validation #1686 The applicant clicks on a link that is emailed to them, then provides consent and validate their identity by capturing images of the front and back if their photo ID and a selfie VID – Validate Identity If the applicant fails the mID process, the applicant will be instructed to upload two pieces of ID (one must be government issued),...
POINT OF CONTACT INFORMATION. Identify the person who will serve as the project team point of contact for this request. This person is responsible for communicating questions and IRB decisions to project team members at all sites. (The project team Point of Contact could be the Principal Investigator or an individual coordinating the project.) Name: Click or tap here to enter text. Email: Click or tap here to enter text. Phone Click or tap here to enter text. External Site Information Name of collaborate/external research institution: Click or tap here to enter text. Name of contact: Click or tap here to enter text. Email address: Click or tap here to enter text. Phone: Click or tap here to enter text. Recruitment procedures will be conducted at external site as outline in the Research Plan, if applicable: Will external site researchers review medical records prior to consent to determine eligibility? ☐ Yes ☐ No If yes, specify source of records? Click or tap here to enter text. Consent process will be conducted at external site as outline in the protocol? ☐ Yes ☐ No If not included in the Research Plan or if different than in the Research Plan, explain the process for the external site: Click or tap here to enter text. Submit this entire form along with the Research Plan*, to xxxxxxxx@xxxxxxxx.xxx.
POINT OF CONTACT INFORMATION. Identify the person who will serve as the project team point of contact for this request. This person is responsible for communicating questions and IRB decisions to project team members at all sites. (The project team Point of Contact could be the Principal Investigator or an individual coordinating the project.) Name: Click or tap here to enter text. Email: Click or tap here to enter text. Phone Click or tap here to enter text. Proposed ceding IRB information, if the institution has an IRB and FWA Name of collaborate research insitution: Click or tap here to enter text. Name of contact: Click or tap here to enter text. Email address: Click or tap here to enter text. Phone: Click or tap here to enter text. Funding Information Funds will leave Xxxxxxxx through: ☐ direct award/contract ☐ sub-contract ☐ service agreement ☐ Not funded External Site Information Recruitment procedures will be conducted at external site as outline in the Research Plan, if applicable: Will external site researchers review medical records prior to consent to determine eligibility? ☐ Yes ☐ No ☐ NA If yes, specify source of records? Click or tap here to enter text. Consent process will be conducted at external site as outline in the protocol? ☐ Yes ☐ No ☐ NA If not included in the Research Plan or if different than in the Research Plan, explain the process for the external site: Click or tap here to enter text. When requesting that CU be the IRB of Record submit this entire form along with the Research Plan* and consent form, if applicable, to xxxxxxxx@xxxxxxxx.xxx.
POINT OF CONTACT INFORMATION. For CLSCC: For UTC: Xxxxx Xxxxxx Xxx Xxxxxx Director of Enrollment Services Director of Undergraduate Admissions Email: xxxxxxx@xxxxxxxxxxxxxxxx.xxx Email: Xxx-Xxxxxx@xxx.xxx Phone: 000-000-0000 Phone: 000-000-0000
POINT OF CONTACT INFORMATION. Xx. Xxxxxxxx Xx Vera, Contract Specialist Environmental Acquisition Core Naval Facilities Engineering Command Southwest 0000 Xxxxxxx Xxxxxxx San Diego, CA 92132 619.532.1810 Timeline for Review of Statements of Interest: We request that Statements of Interest be submitted by April 20, 2015 May 21, 2015 at 2:00
