Membership Application Form

SOCRA Membership Application

To apply for or renew your membership, complete and submit the form below.
SOCRA Membership Application Policies / Information:
- Membership fees ($75 USD/year) are processed immediately and are not refundable or transferable.
- The membership packet is emailed at the beginning of the following week in which payment is received.
- 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.
- If you are a current member, Renew through the Membership Renewal Application.
- If you hold an active CCRP certification, your SOCRA membership is included and does not need to be purchased or renewed separately.
First Name
Middle Name Initial
Last Name
Name Prefix:

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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

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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, please share member ID
Current Member? Renew through the Membership Renewal Application.

Active CCRP certified do not need to apply separately, as SOCRA membership is included with certification.

Membership Type

1 Year Membership

$75.00

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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
Please allow up to 5 business days for your membership information to be sent via email.
This is not CCRP Certification Exam Application

Click here for CCRP Certification Exam Appliation.
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SOCRA Membership Application

SOCRA Membership Application Policies / Information:

Membership Type*

Membership Type