Global Asthma Network
Global Asthma Network Registration Document
1. Instructions
A. Please complete this Registration Document to register as an Global Asthma Network Centre
B. Once completed, please return the Registration Document to the Global Asthma Network Coordinating Centre: Philippa Ellwood: Email address:
Region:
Email:
Website: Global Asthma Network 20151
Global Asthma Network
Country Name
Centre Name
Country Number
Centre Number
Email:
Website: Global Asthma Network 20151
2. Principal Investigator (PI) details:
(These will be checked against your details already entered into the Global Asthma Network data base to ensure we have the correct information)
Name:
Position:
Institution:
Postal Address:
Physical Address:
(for couriers if
different to
postal address)
E-mail:
Telephone:
Fax:
2a. AdultPrincipal Investigator (PI) details (if applicable):
(Enter only if your centre is completing the adult questionnaire and the Adult PI is different to the main PI)
Name:
Position:
Institution:
E-mail:
3. Other main collaborators (Names. addresses and role)
Please state the name of the person and their email address, that the Global Asthma Network Coordinating Centre will be communicating with if different from the PI.
Name:
E-mail:
4. Questionnaires to be used in your study centre
Email:
Website: Global Asthma Network 20151
a) Questionnaire for 13/14 year olds(compulsory)Yes☐No☐
(Compulsory questions are 1-30)
b) Video questionnaire for 13/14 year oldsYes☐No☐
[International version)] (recommended)
c) ADULT questionnaire for parents of 13/14 year oldsYes☐No☐
(recommended. If used, compulsory questions are 1-24)
d) Questionnaire for parents of 6/7 year olds Yes☐No☐
(recommended. If used, compulsory questions are 1-33)
e) ADULT questionnaire about parents of 6/7 year olds Yes☐No☐
(recommended. If used, compulsory questions are 1-24)
Additional Questions
f) Are you planning to add other questions to these questionnaires?Yes☐No☐
Email:
Website: Global Asthma Network 20151
If YES, please provide brief details and send a copy of the questions to the Data Centre if these have been developed.
Details of your additional questions
5.What language/s will be used for your questionnaires
Email:
Website: Global Asthma Network 20151
EnglishYes☐No☐
Email:
Website: Global Asthma Network 20151
Other/s
(Please specify in the box below)
Please follow the translation guidelines from the link below and send a copy of your translation and back translation to English to
6.Proposed starting date for your study
Proposed Start date
Email:
Website: Global Asthma Network 20151
Date unknown☐
Email:
Website: Global Asthma Network 20151
7.Data sharing
I agree that my data can be made available on the Global Asthma Network website following completion of the data analysis for the global publications of which I will be a contributing member of the study group.
Yes☐No☐
8.Declaration
I agree to undertake the Global Asthma Network fieldwork according to the protocols of the Global Asthma Network (
Name:
Signature: Date:
Email:
Website: Global Asthma Network 20151