Wednesday, Jun 28th

Last update08:49:59 PM GMT

GAMBA Citizen Panel on Osteoarthritis Research in Galway 2012
  1. The Citizen Panel will take place on Saturday, May 19th and Sunday, May 20th as well as Saturday, June 9th and Sunday, June 10th 2012 from 10 am to 6 pm in Galway (University). We also offer the option to visit the research labs at NUIG. Please note that you will need to be available for ALL days. You will receive an expense allowance of EUR 50.00 for your participation. Please click for further information.
  2. Invalid Input
  3. Your Details
  4. Gender:*
    Invalid Input
  5. Name:*
    Invalid Input
  6. First Name:*
    Invalid Input
  7. Year of Birth:*
    Invalid Input (max. 4 numbers are allowed)
  8. Nationality:*
    Invalid Input
  9. Occupation:
    Invalid Input
  10. At what age did you finish your formal full-time education?
  11. Age:
    Invalid Input
  12. Address:
    Invalid Input
  13. Email:*
    Invalid Input
  14. Phone
    Invalid Input
  15. Are you suffering from osteoarthritis yourself? If yes, since when:
  16. Year:
    Invalid Input
  17. Which Symptoms are you suffering from? (affected joints, pain, inflammation, degeneration of cartilage and/or bone):
  18. Symptoms:
    Invalid Input
  19. Which future therapy approaches are promising in your opinion?
  20. Future therapy approaches:
    Invalid Input
  21. Have you heard about ...

  22. Invalid Input
  23. Would you like us to call you?
  24. Invalid Input
  25. Important! Please return by May 4th, 2012!
  26. Thank you for your interest!
    If you have any queries about the panel please contact Christine Ritter: SWIT0003.GIF 091 49 4276.

    Your GAMBA panel team
    (responsible: Dr. Katharina Zoeller, ScienceDialogue, Germany)

    Data protection information:
    Your data will be treated in strictest confidence. It will only be used for the organization and execution of the planned Citizen Panels on osteoarthritis research. Your data will be stored and evaluated for this purpose only. Your data will not be passed on to third parties.
  27. Confirmation:*
    Invalid Input
  28. Anti-SPAM Code
    Anti-SPAM Code
      RefreshInvalid Input
  29. * = required

Member Area Login

Sign in with Facebook
You are here: Outreach to the public Panels Patient and Citizen Panels GAMBA Citizen Panel on Osteoarthritis Research in Galway 2012