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  • The Global Asthma Network strives for a world where no-one suffers from asthma

  • The Global Asthma Network is the asthma surveillance hub for the world

  • The Global Asthma Network researches ways of reducing the burden of asthma

  • The Global Asthma Network promotes access to appropriate asthma management

  • The Global Asthma Network stimulates and encourages capacity building in LMICs

  • The Global Asthma Network strives to ensure access to quality-assured essential asthma medications

  • The Global Asthma Network raises the profile of asthma as a major NCD

Global Asthma Network Center Registration Form

Phase I Global Surveillance: Prevalence, Severity, Management and Risk Factors

The Global Asthma Network is now taking formal registrations from centres interested in participating in the Global Asthma Network. To register as a Phase I Global Asthma Network Centre, please fill out the form below. Alternatively, you may download the registration form word document, complete, and email back to Philippa Ellwood (p.ellwood@auckland.ac.nz) or alternatively send it by fax (64 9 3737602).

Each Global Asthma Network centre will be led by one Principal Investigator. Each centre will be required to find their own funding.

We welcome your involvement.

Please note: Some browsers may display a warning in the address bar that this page is not secure. This simply means that the information you enter in the page forms will not be encrypted when it is sent to and saved on the website from your computer.

Region
Country
Centre Name
Country and Centre Number (if known):
Country Number: Centre Number:

Principal Investigator (PI) details

(These will be checked against your details already entered into the Global Asthma Network data base to ensure we have the correct information)
Title
First names
Family Name
Position
Institution
Postal Address:
Physical Address:
(Street address for courier deliveries if different to postal address)
Phone
Fax
email

Adult Principal Investigator details

(Enter only if your centre is completing the adult questionnaire and the Adult PI is different to the main PI)
Title
First names
Family Name
Position
Institution
email

Other main collaborators

(Names email addresses and role)

Please state the person and their email address that the global asthma network coordinating centre will be communicating with if different from the PI:

Title
First names
Family Name
email

Questionnaires to be used in your study centre

a)  Questionnaire for 13/14 year olds (compulsory)
(Compulsory questions are 1-30)		 Yes No
b)  Video questionnaire for 13/14 year olds
[International version)]  (recommended)		 Yes No
c)  ADULT questionnaire for parents of 13/14 year olds
(recommended. If used, compulsory questions are 1-24)		 Yes No
d)  Questionnaire for 6/7 year olds (parental completion)
(recommended. If used, compulsory questions are 1-33)		 Yes No
e) ADULT questionnaire about parents of 6/7 year olds 
(recommended. If used, compulsory questions are 1-24)		 Yes No

Additional Questions

f)  Are you planning to add other questions to these questionnaires?
Yes No

If YES, (to f) please provide brief details and send a copy of the questions to the GAN Global Centre if these have been developed. (info@globalasthmanetwork.org)
Details of your additional questions

What language/s will be used for your questionnaires

English
Other/s (Please specify)
Please follow the translation guidelines from the link below and send a copy of your translation and back translation to English to p.ellwood@auckland.ac.nz
http://www.globalasthmanetwork.org/surveillance/manual/translation.php

Proposed starting date for your study

Proposed Start date
Date unknown

Data sharing

I agree that my data can be made available on the Global Asthma Network website following completion of the data analysis for the global publications of which I will be a contributing member of the study group. Yes No

Declaration

I agree to undertake the Global Asthma Network fieldwork according to the protocols of the Global Asthma Network
Name:

For any concerns or queries regarding the registration process, please contact Philippa Ellwood.

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