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Coalition for Clinical Trial Equity Interest Form
Thank you for your interest in joining The Coalition for Clinical Trial Equity (CCTE). Please complete the following questionnaire so we can learn more about your interests, expertise, and desired work group. Please note, completing this form will not guarantee coalition membership.
Coalition Membership
• Non-Profit Membership is
complementary
• Industry/For-Profit Membership fees are tiered by company budget:
Less than $1 million: $1000 annual membership fee
$1 million - $5 million: $2500 annual membership fee
$5 million - $10 million: $5000 annual membership fee
$10 million - $25 million: $7,500 annual membership fee
Over $25 million: $10,000 annual membership fee
** Join the Champions for Change - Paid Time Off Initiative by March 2025 and unlock exclusive coalition member benefits. To join the Champions for Change - PTO Initiative you must provide at least one paid day off for employees participating in a clinical trial). **
Select all that apply:
I am interested in joining the coalition as a representative of a non-profit organization.
I am interested in joining the coalition as a representative of an industry/for-profit organization.
The Coalition for Clinical Trial Equity launched a Paid Time Off Initiative to encourage corporations and employers across the country to commit to providing paid time off for employees to participate in clinical trials. To join the initiative as a partner, employers must commit to providing at least one day of paid leave per year for a minimum of two years. Please indicate your interest in joining this initiative below.
I would like to learn more about the Paid Time Off Initiative.
I understand the commitment and would like to join the Paid Time Off Initiative.
I am not interested in this program at this time.
Please provide the following information.
Point of Contact First & Last Name
Title
Organization/Institution (Note: Membership is for the organization/entity, not the individual):
Please provide the following contact information.
Contact Phone
Contact Email Address
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