Ean NEuro-covid ReGistrY (ENERGY)             Contact Information
Thank you for your interest in contributing to the EAN Neuro-COVID Registry (ENERGY). Please provide some contact details and info about your institution (site) in the form below.

We will then follow up with all eligible institutions to provide further information on the Registry.

You will receive a response within 3 working days.

For enquiries please email: covidregistry@ean.org


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Email *
Your Name *
Your role in the department *
Are you an EAN Member?
Contact Phone number
Name of your Institution *
Name of your Department *
Address
Street *
City *
Postcode
Country *
I confirm that the head of my department agrees with participating in ENERGY. I agree that the data collected will be used for receiving information on ENERGY. *
Required
I agree to receive information on other EAN activities *
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