Research Project Promotion Request

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* 1. Name of the research project

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* 2. Name of the chief investigator

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* 3. Position of the chief investigator

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* 4. Affiliation of the chief investigator

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* 5. Name of primary contact person for the research project

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* 6. Contact phone number

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* 7. Contact email address

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* 8. URL for a web page where prospective participants can find necessary information

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* 9. Do you have approval from a human research ethics committee (HREC) for the research project?

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* 10. HREC approval number for the project or reason for not having HREC approval

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* 11. Information about the research project to inform prospective participants about the background, aims, and what is involved

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* 12. End date of the research project

End date

Date

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* 13. Start date for the research project

Start date

Date

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* 14. Please confirm agreement with the following statement:

I agree to provide a plain English summary of the research project, after completion of the study, for distribution by Healthy Male