Title of the group leader (GL) *
Professor Doctor Mr Mrs Miss Ms Your title (required).
First name of the group leader (GL) *
Your given name (required).
Last name of the group leader (GL) *
Your family name (required).
Job title of the group leader (GL) *
Your position within the institution (required).
Institutional email address of the group leader (GL) *
Use of an institutional email address issued by your place of work is part of our verification process. If you do not have one, enter your usual email address here, but please contact help@rd-connect.eu to explain your circumstances (required).
Name of your department *
Your department within your institution (required).
Department web profile
If you have a link to your department profile, where your group is listed, please paste it here.
Url must start with http:// or https://
Name of your research group

Short summary of research interests *
In two or three sentences, please describe your research interests and how access to the RDC-GPAP will be of benefit to you (required). If you are involved in any of the following projects, please select one of the answers below
NA Solve-RD NeuroGenetics ERDERA
3 recent publications (PMIDs)
Please enter PubMed ID numbers for up to 3 recent relevant publications, separated by commas.
ORCID profile
If you have an ORCID ID please paste the link to your profile here.
Url must start with http:// or https://
ResearchGate profile
If you have a ResearchGate profile please paste the link here.
Url must start with http:// or https://
LinkedIn profile
If you have a LinkedIn profile please paste the link here.
Url must start with http:// or https://

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1.2 Personal Information of the legal representative

Title of the legal representative *
Professor Doctor Mr Mrs Miss Ms Legal representative's title (required).
First name of the legal representative *
Legal representative's given name (required).
Last name of the legal representative *
Legal representative's family name (required).
Job title of the legal representative *
Legal representative's position within the institution (required).
Authorisation statement or supporting document confirming that the Legal Representative is entitled to act on behalf of your institution. * Example: ‘[Name], in their capacity as Director of the institution, is authorised to act as Legal Representative, as approved by the [Board Name] on [Date].’ Example: in virtue of appointment by the [Board Name] on [Date].
(required)

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2. Institutional Information

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Name of institution *
The institution (university, hospital etc.) with which you have your primary affiliation (required).
Acronym for institution
If there is an acronym for your institution, please provide it here.
Institute website *
Your institution's main website (required)
Url must start with http:// or https://
Institution type *
Public Institution University University Hospital Healthcare Facility Public Hospital Private Hospital Biobank Patient Registry Commercial Entity Other The nature of your institution (required).
Tax registration number of the institution *
Provide the institution's tax number (required).
Country of the institution *
Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central Africa Chad Chile China Colombia Comoros Congo Congo (Dem. Republic) Costa Rica Croatia Cuba Cyprus Czechia Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea North Macedonia Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe The country of your institution's head office (required).
City of the institution *
The city of your institution's head office (required).
Address of the institution *
The address of your institution's Head Office
If your country is a non-EU country and does not have an adequate level of data protection (see here ) we will contact you by email to also fill in and sign the Data Transfer Agreement and the Data Access Agreement (required).

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