Participation form

Please fill in your details

We will automatically send the information below to the research institute that conducts this trial. They will then contact you to discuss the possibilities of your participation.

Attention: Submitting the form below is completely non-committal; you may decide to refrain from participating at any time.

Fields marked with * are mandatory

Personal details First name *

Surname *

Gender * Male Female

Date of birth *

I smoke * yes no

How many cigarettes a day *

Contact information Street address *

Number *

Suffix

Postal code *

Place of residence *

Country *

Telephone number *

Email address *

Repeat email address *

Questions and/or remarks I agree to the Terms and Conditions and the Privacy statement of Medians. By submitting this participation form, I agree that my details will be automatically sent to the research centre conducting the trial.

Conducted by Pierre Fabre

Male or female Gender: Male or female
30-55 Age: 30-55 years
Between 0 and 40 kg/m2 BMI: Between 0 and 40 kg/m2
Toulouse Location: Toulouse
€ 100,- Compensation: € 100,-
Travel expenses

Rosacée