Bristol-Myers Squibb: Investigator Inquiry form

Investigator Inquiry Form

Like any other scientific endeavor, drug research and development is a complex, time-consuming, resource intensive process with no guaranteed results. Bristol-Myers Squibb is committed to pursuing such research and development and, in doing so, helping patients to prevail.

If you are an investigator interested in conducting clinical research with Bristol-Myers Squibb, please fill out this form.


*	1.Designate your geographic location:
	U.S.- based Investigator Non-U.S.- based Investigator
*	2.What is your specific area of interest:
*	3.Is there a specific study you are interested in?YesNoStudy Number:
*	4.Do you have previous experience in conducting clinical trials?YesNo
	5.If yes, briefly list the type(s) of trials, when they were conducted and the companies they were associated with.
*	6.Have you previously conducted any Bristol-Myers Squibb trials?YesNo
	7.If yes, briefly list the type(s) of trials and when they were conducted.
	8.Please provide us with the following contact information:
*	First Name:
*	Last Name:
*	Email Address:
	Company/Practice Name:
	Address 1:
	Address 2:
	City:
	State/Province/Zip:
*	Country:
*	Telephone (incl. country code):
	Fax Number:
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