Research collaboration registration (new institue/hospital)

Indicates required field

Contact Information (Department / Section lead)

Title

First name

Last name

Credentials

Phone

Department / Speciality name

Hospital / Institute name

Professional society association/membership(s)

ISDE

ESDE

STS

ESTS

CSDE

JES

AUGIS

DUCA

Others

Case volume ( Esophagectomies / year )

1-25

26-50

51-75

76-100

101-150

151-200

201-300

301-500

>500

Current clinical trials/research involvement

No current research activities

At least one project

Multiple projects

Current participation or data collection/contribution

Institutional level data

Regional / national registry

International

Current project(s) details

Provide us with a list of publications or presentations involving esophageal disease/cancer that have involved you or members of your team over the last five years.

Provide us with a list of publications or presentations involving esophageal disease/cancer that have involved you or members of your team over the last five years.
	Provide us with a list of publications or presentations involving esophageal disease/cancer that have involved you or members of your team over the last five years. Publication title Link to the publication	Item weight

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Additional research

Additional research information

Paste a list of publications from your institute / research

Research collaboration registration (new institue/hospital)

Contact Information (Department / Section lead)

Additional research?

Additional research