SIR Foundation Letter of Intent
Name of clinical research study or clinical registry
Proposal description (approximately 300 words)
Start Date/End Date
Patients: number to enroll
Sites: number to participate
Potential funding sources
Desired outcome of data
(ie. data to ensure procedure is reimbursed, m
anuscript, etc)
SIR's Foundation specific role in this process (ie, managing project timeline, recruiting sites, finding funding opportunities)
Please submit any related files to assist with this process (ie synopsis, protocol, and budget)
Lead Investigator's Information
Name
E-mail
Institution/Affiliation
Please submit the lead investigator's CV.
Contact Information