APOLLO Expression of Interest Form

Please fill in this form if you are interested in taking part in the global APOLLO study delivered by the EuroSurg Collaborative.

Please check if you already have a local lead using the following app: APOLLO Local Lead Shinyapp

PRIVACY NOTICE - Please ensure you read this document
You can find out what we do with your data in our Privacy Notice.
If you are entering personal information for other collaborators in your team please make them aware of the privacy notice.

If you are joining the study from the UK please email your STARSurg Regional Lead (https://eurosurg.org/wp-content/uploads/2022/11/Apollo-regional-leads.pdf)

Have you checked there is no lead for your centre?

* must provide value

Yes

reset

Please check if you already have a local lead using the following app: APOLLO Local Lead Shinyapp

Enter your first name

* must provide value

Enter your last name

* must provide value

Enter your email address

* must provide value

What is your level of training?

* must provide value

Medical student

Junior doctor, registrar/resident, trainee

Consultant

reset

What role would you like to have in APOLLO?

* must provide value

Data collector

Hospital/Local lead

reset

Enter your hospital name

Start typing your country, city, or hospital name to find your hospital in the list

* must provide value

Country

* must provide value

If you are joining the APOLLO Study from the United Kingdom, please contact the appropriate STARSurg Regional Lead to register your site. Contact details of the Regional Leads can be found here: https://eurosurg.org/wp-content/uploads/2022/11/Apollo-regional-leads.pdf

If you are participating from a region without a regional lead - please contact: apollo.eurosurg@gmail.com

City

* must provide value

Hospital name*

*Please provide full name of hospital in English

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.

APOLLO Expression of Interest Form

Your Details

Hospital Details

You have selected an option that triggers this survey to end right now.