Membership Renewal Form

SOCRA Membership Renewal

To renew your membership, complete and submit the form below.
SOCRA Membership Renewal Policies / Information:
- Membership fees ($75 USD / year) are processed immediately and are not refundable or transferable.
- Please allow up to 48 hours for your account to be reactivated.
- SOCRA is an educational and charitable non-profit corporation (Federal Tax ID # 61-1208981); however, your dues are not tax-deductible as a charitable contribution.
- Please note that this is not CCRP recertification. Renewing your SOCRA membership does not qualify as CCRP certification renewal. Click here for Recertification Application.
First Name
Middle Name Initial
Last name
Name Prefix:

Other
Degrees:
Certifications:
Title:
Company/Affiliation:
Address type:
Address

Street Address

Street Address Line 2

CityState

Zip Code
Street Address

Street Address Line 2

CityState

Zip Code
Street Address

Street Address Line 2

CityState/ Province

Zip Code
Street Address

Street Address Line 2

CityState/ Province

Zip Code
Street Address

Street Address Line 2

CityState/ Province

Zip CodeCountry
E-mail
Note: This email address will be used for member emails and access to the Chapter Circle community. Personal email address is recommended.)
Phone type:
Phone Number
Format: (000) 000-0000.
Select your preferred Chapter. Click here for a listing of Chapters.
Some listed Chapters are currently inactive. If that is the case, we will assign you to the nearest Chapter geographically.
Areas of Interest (select all that apply):
Which of the following best describes your primary employment setting?
If a current Member, enter Member ID:
Please note that this fee is non-refundable. This is for SOCRA membership renewal only and does not include CCRP recertification. Renewing your membership will not renew your CCRP certification.

If you are CCRP certified, your SOCRA membership is already included.

Membership Type

1 Year Membership (Renewal)

$75.00

Enter coupon

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

SOCRA Ethics Statement
As a Clinical Research Professional, I recognize and affirm my responsibility to abide by the following basic ethical principles inherent in clinical research:

1. I will respect the human dignity of research participants with regard to self-determination and full disclosure of information throughout the research process.

2. I believe that research participants should be free from harm and exploitation in accordance with the risks and benefits of the research project.

3. I believe that research participants should have the right to receive fair and confidential treatment during the selection process and throughout the research project.

4. Additionally, I will be accountable for adhering to the standards for scientific integrity recognized around the world. This mandates honest and truthful behavior on behalf of myself and by others with whom I deal while engaged in clinical research. I recognize my right and responsibility as a clinical research professional to question suspected falsified data, and if necessary, proceed with appropriate reporting procedures as mandated by the appropriate regulatory agencies.
Signature
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
This is for SOCRA membership renewal only, NOT CCRP recertification

Click here for Recertification Application.
Should be Empty:

SOCRA Membership Renewal

SOCRA Membership Renewal Policies / Information:

Membership Type*

Membership Type