Scleroderma Clinical Trials Consortium

Full institution name including affiliated medical school (if any):
*Coordinating investigator:* Full name and degrees	email address
Other institutional participants Full name and degrees	email address
Full name and degrees	email address
Full name and degrees	email address
Full name and degrees	email address
Please note that email is the method used for most SCTC communications. Please also note that the name, office addresses, and email addresses will be available on the SCTC website.
*Mailing address:* Street/Building line 1
Street/Building line 2
City
State/Province
Country
Zip code/Postal code
Telephone No. including country code	Fax No. including country code
Please complete the following regarding criteria for full membership:
Our institution has a dedicated clinic for scleroderma.	Yes No
Our institution has participated in the following scleroderma clinical trials (include sponsor): 1.
2.
3.
Our institution has published at least one refereed manuscript within the last five years describing clinical aspects of scleroderma.	Yes No
If yes, please list reference(s) below: 1.
2.
3.
Initiation dues are US $250.00 to be paid in US dollars. Annual dues are US $200.00. Payment will be invoiced to coordinating investigator listed above and is due upon invoice receipt. 2006