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PROJECT TITLE

Short Title

20-100 characters long to be used in invitations and social media

Long Title

20-1000 characters long

LEAD ORGANISATION

Name

ABN

CHIEF INVESTIGATOR CONTACT DETAILS

Title/Full Name

Organisation

Address

Telephone Number

Email (CI)

Primary Contact

Yes

STUDY COORDINATOR CONTACT DETAILS

Title/Full Name

Organisation

Address

Telephone Number

Email (SC)

Primary Contact

Yes

PRIMARY CONTACT DETAILS

Title/Full Name

Organisation

Address

Telephone Number

Email (PC)

ETHICS APPROVAL

Does your study have ethics approval from a recognised HREC?

Yes

HREC Committee Name

Approval Number

Please attach:

Approval Letter from your HREC
Study Protocol
Participant Information Statement & Consent Form

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If HREC Approval is not Required:

Please provide justification or attach statement from HREC that ethics approval not required for this study

STUDY SUMMARY [500 WORDS]

Brief summary [max 500 words] in lay language. Include study description, eligibility criteria, what’s involved, benefits (gift vouchers, etc.) and name of study sponsor.

The register will send this to all eligible participants.

DEMOGRAPHIC CRITERIA

Age

Not Applicable

Minimum age

Maximum age

Language spoken at home

Not Applicable

Click and hold Control key to select more than on languange

Other: please state

Country of Birth

Not Applicable

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Location

Not Applicable

Please specify state(s), territor(ies) or postcode(s)

NUMBER OF PARTICIPANTS

Total sample size

# records per cohort

STUDY TIMEFRAME

Data collection

Analysis

Reporting

FOR STUDIES ACCESSING STUDY PARTICIPANTS

Please identify the contact person for selected participants to find out more about your study.

Name

Position

Phone

AGREEMENT

We agree to:

report on the number of study participants recruited from the Join Us register

include the Join Us register as a recruitment source in published reports from the study

use de-identified data in accordance with the requirements of the register and as described above

STUDY RELATED ASSETS

Please upload:

Study protocol
Participant information sheet
Consent form
Study logo/ feature image

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	Include	Exclude
Female
Male
Other

	Include	Exclude
Aboriginal
Torres Strait Islander
Aboriginal and Torres Strait Islander