CANADIAN ASSOCIATION OF RESEARCH ETHICS BOARDS
ASSOCIATION CANADIENNE DES COMITES D'ETHIQUE DE LA RECHERCHE
("CAREB - ACCER")

CAREB - ACCER MEMBERSHIP FORM

Annual Membership April 1, 2011 to March 31, 2012

Simply fill out all of the necessary information directly on the form, print the form and you MUST mail the completed form along with your payment made out to Canadian Association for Research Ethics Boards (CAREB - ACCER) to:

Patrick Clifford
Director of Research
The Research Institute at Southlake
Medical Arts Building, Suite 512
596 Davis Drive
Newmarket Ontario, L3Y 2P9
905-895-4521 ext. 2387
Fax 905-952-3068
pclifford@southlakeregional.org

Inquiries: For membership, please contact Patrick Clifford at (905) 895-4521 or email: pclifford@southlakeregional.org

All fields must be completed carefully as this information is used for the CAREB Directory

First Name:
Last Name:
Title:
Office:
Organization:
Title of REB:
Address:
Apt/Suite:
City:
Province:
Postal Code:
Telephone:	()
Fax:	()
Email:
MEMBERSHIP is $75..00
Pay with Credit Card or PayPal?: YES	NO
Total Payment:$
PLEASE PRINT
If you choose PAYPAL, after you submit this form you will be taken to a page where you should click the SUBSCRIBE button to make your payment.
You should only need to Submit the form ONCE. If you wish to make a change after you submit, please contact registration@careb-accer.org. There is no Mass subscription. If you are registering a group from an institution, please use individual names and submissions.