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Melbourne Health Investigator Curriculum Vitae First and Family Name: Present appointment: (Job Title, Department) Address Full work address including postcode Qualifications Degree and other professional qualifications PhD MBBS BN MSc BSc Other: ( relevant qualifications, or specify) Registration/licence number (if applicable) Previous appointments/ experience (include only relevant therapeutic/ practical experience after gaining qualifications) Publications ( appropriate box) (Number of articles published) Previous experience in clinical trials 0 0–5 6-10 Protocol design Recruitment Consent 11-20 >20 Trial procedures Other – please describe below: Data collection Data management Training (accredited courses) GCP Research Ethics Other – please describe below: Research Conduct List all HREC projects that you currently hold the role of investigator (Principal and/or Associate) Signature: Date: Curriculum Vitae template Version 1, October 2007