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Global Safety Assessment Network (GSAN) Registration

 

NUCLEUS Username *

Please provide your exact NUCLEUS user name here. If you have not yet registered with NUCLEUS, use the NUCLEUS Registration link. (You will be taken back to this page following registration)

First Name *
Please enter your first name here.

Last Name *
Please enter your last name here.

Organization *
Please indicate your organization's full name here (no abreviations).

Title *
Please indicate your title or area of responsibility in your organization.

E-Mail Address *
Please provide your e-mail address. It will not be shared with anyone outside the GSAN Platform.

Purpose of Requesting Access *
Indicate your reasons for requesting access to this Web site and the area(s) you are interested in. If you are requesting access to Activities, please specify the project name.

Country *

Please specify your country of residence.

Type of Organization *


Please specify the type of organization in which you are working.

Area of interest/expertise *

Please select one or more areas you are interested in or in which you have expertise.

If other, please specify
Attachments
 
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