IIR Investigator / Site Personnel Registration

Principal Investigator (mandatory)

First Name^*

Please enter first name

Last Name^*

Please enter last name

Country^*

Please select country

Degree

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Organization/Institution^* (Select “Other” if the Organization is not listed)

Please select organization/institution

New Organization/Institution^*

Please enter new organization/institution

Department^* (Select “Other” if the Department is not listed)

Please select department

New Department^*

Please enter new Department

City^*

Please enter city

State^*

Please select state

Address^*

Please enter your address

Postal Code^*

Please enter postal code

Email^*

Please enter email

The email address entered is not valid

The email must not contain "@bayer"

Telephone(Only enter "+" and numeric values)

Are you already in contact with Bayer, if yes, please provide the Name

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Site Personnel, e.g. Operations Manager, Coordinator, etc. who enters proposals on behalf of Principal Investigator (Optional)

First Name

Please enter first name

Last Name

Please enter last name

Please enter email

The email address entered is not valid

The email must not contain "@bayer"

I confirm registration was completed by:

Principal Investigator Site Personnel Other Person (please enter contact information below)

Select atleast one of the options

You have entered another person details. Kindly check another person checkbox.

First Name

Please enter first name

Last Name

Please enter last name

Please enter email

The email address entered is not valid

The email must not contain "@bayer"

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