Sign-Up form - Endo-ERN e-Reporting
Email address *
SECTION 1 - CONTACT DETAILS
Title of respondent (Dr, Professor, Other) *
Surname *
First name *
Hospital Base *
Would you like to be involved in the co-ordination or management of the Endo-ERN e-Reporting? *
I would like to nominate myself to report on the conditions listed in Section 2 *
I would like to report on cases that are *
I would like to nominate the following member(s) of my team to report on specific conditions
The form can be forwarded to other team members for them to complete or we can contact them directly
Name + MTG + Age group (<18 and/or ≥ 18)
E-mail address(es)
SECTION 2 - LIST OF ENDO-ERN CONDITIONS
MTG1 Adrenal
MTG2 Calcium & Phosphates
MTG3 Glucose & Insulin
MTG4 Genetic Endocrine tumours
MTG5 Growth & Genetic Obesity
MTG6 Pituitary
MTG7 Sexual Development & Maturation
MTG8 Thyroid
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