ACR _ Application form

ID and Password Application Form for Asia CML Registry

Please fill out this application form to obtain a user ID and password for Asia CML Registry (ACR).
Your user ID and password will be emailed to you after ACSA office reviews your application.

Please note the following:: Only one user ID will be provided to individual site (or hospital).
ACSA will present registration status twice at EHA meeting (June) and at ASH meeting (December) every year.
Activity of account will be reviewed at the above meeting, and User ID of inactive account may be
terminated by the decision of SSC (Scientific Study Committee) in ACSA.

Registration

Registration
First Name		Middle Name
Last Name		Title
Name of Principal Investigator
Organization
Department
Street address
City		State/Province
Country		Zip Code
Work phone		Fax
E-mail
Comment
0 + 1 =

You can send us this form with other requiring by fax to the following Fax number: (822) 785 1198 or (822) 593 2522: OYou may also send us scanned images of the form with accompanied documents.
Email to: saheepark@catholic.ac.kr
Asia CML Study Alliance Office Catholic Research Institute of Medical Science, Banpo-dong, Seocho-gu, Seoul, South Korea