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1. The database entrance is applied for address of the user for this one
(if you don't need database access you don't have to fill out that form)
[ SHOW FORM ]
Data Manager:
First name:
Last name:
Title: MD   PhD   Mag.   DI   MBA
Professor   Associate Professor/Private Dozent  
Type of organisation: university/hospital
company
institute
other
Organisation name:
Address:
Zip code:
Town:
Country:
Phone:
Mobile:
Fax:
Email:
Website:

2. Invoice address (if different to 1., only use of profiles or advertising only)
[ SHOW FORM ]
First name:
Last name:
Title: MD   PhD   Mag.   DI   MBA
Professor   Associate Professor  
Organisation name:
Address:
Zip code:
Town:
Country:
Phone:
Mobile:
Fax:
Email:

3. Services
[ SHOW FORM ]
USE of SciCoMed Database + Profile module:
Annual fee
Obstetrics, Endometriosis (incl. SEF-Datenblatt), Osteoporosis,Fetal Malformation, Assisted Reproduction or MonoReg database
500.- EUR (incl. value added tax of 20 %) including 2 subusers
 
Additional subuser
180.- EUR (incl. value added tax of 20 %)
 
Profile module - free of charge
 
SEF Datenblatt
240.- EUR (incl. value added tax of 20 %)
 
Creation of an on-demand Database solution or a documentation sheet according to the offer
 

 

4. Profile data
[ SHOW FORM ]
User data:
  [copy from invoice data]   [copy from datamanager data]
First name:
Last name:
Title: MD   PhD   Mag.   DI   MBA
Professor   Associate Professor  
Organisation/company name:
Department/clinical institute for:
Address:
Zip code:
Town:
Country:
Phone:
Mobile:
Fax:
Email:
Your company logo (.jpg):
Your photo (.jpg):
Publications:
Field(s) of research:
[ add another field ]
Expertise(s):
[ add another expertise ]
Material
Longitudinal sampling
Sample in state of disease
Disease:
Serum   /   Number of samples:
Plasma   /   Number of samples:
Urine   /   Number of samples:
EDTA   /   Number of samples:
Umbilical cord blood   /   Number of samples:
Placenta   /   Number of samples:
Storage:
Refrigerator
Freezer: -20°   -40°   -80°
[ ADD REQUEST/OFFER ]

5. Voucher code(s)
If you have received any voucher codes, please enter them here exactly as they appear on your voucher:

6. Unique User-ID for multicenter studies
You can create your own and unique User-ID in your profile administration area


You only have to chose username/password for database use or profiles
Username:
Password:
Confirm password:

Provided that you don't carry out the order (see above) for yourself but in the order of an organization, you make sure whether you are entitled to it.
You consent to the processing of person-related data for yourself and/or for the organization represented by you for purposes described by SCICOMED e.U. the general Terms and Conditions.

Acceptance of the "Allgemeine Geschäftsbedingungen" (General Terms and Conditions):
I accept the 'AGB'
 
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