中国帕金森病及运动障碍疾病多中心数据库及协作网（PD-MDCNC）

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Personal Information

Name *

Gender *

Date of birth *

ID Card Number *

Professional Information

Highest Academic Qualification

Academic Degree *

Professional Title *

Professional Expertise and Research Direction *

Job Information

Work Unit's Full Name *

Department *

Work Unit's Address *

Postal Code *

Phone/Cellphone Number *

Email Address *

Fax Number

Supporting Materials

*Cooperation Agreement：

Please download the cooperation agreement, scan and upload it after signing

Upload signed and scanned cooperation agreement

*the front photograph of ID card：

1. Please upload scanned copy or clear picture of your ID card

2. Photos should be in JPG/JPEG/GIF/PNG format and no more than 3M in size

*the back photographof ID card：

*One of the three is fine：

Doctor qualification license

1. Please upload documents that demonstrate your competence in medical field

2. Photos should be in JPG/JPEG/GIF/PNG format and no more than 3M in size

Doctor practice license

1. Please upload documents that demonstrate your competence in medical field

2. Photos should be in JPG/JPEG/GIF/PNG format and no more than 3M in size

Professional title certificate

1. Please upload documents that demonstrate your competence in medical field

2. Photos should be in JPG/JPEG/GIF/PNG format and no more than 3M in size

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Parkinson's Disease & Movement Disorders Multicenter Database and Collaborative Network in China（PD-MDCNC）v7.0 中国帕金森病及运动障碍疾病多中心数据库及协作网