Membership Application for Biobanks
RequiredRequired Question(s)

This form is for application to the categories of Member or Provisional Member of the Confederation of Cancer Biobanks.
 
For more information on the criteria for becoming a Member see www.ncri.org.uk/ccb/howtojoin.html or contact ccb@ncri.org.uk

 

Part I: General Information and Contact Details

 
Required 1.

Name of Biobank:

 

50 characters left.
Required 2.

Name of the Biobank Director:

 

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Required 3.

Email address of the Biobank Director:

 

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Required 4.

Please provide details of the Contact Individual at your Biobank who should be kept informed directly of the work and meetings of the Confederation (eg Biobank Manager).


First Name:
Last Name:
Job Title:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
Postal Code:

5.

Biobank website address:

 

50 characters left.
Required 6.

Please indicate which of the following best describes your biobank:
(select all that apply)

Samples from cancer patients
Samples from healthy volunteers
Samples for cancer research
Samples for research into non-cancer diseases
Population biobank
Other  
Required 7.

Which membership category are you applying for?

Member
Provisional Member
Don't know
  • Comment:

  • 500 characters left.

Part II: Ethics and Legal Requirements

 
Required 8.

 Do you have approval from a Research Ethics Committee (REC)?

Yes (please provide date of approval, approval number and date for renewal)
No (provide details of REC application, if planned)
  • Comment:

  • 500 characters left.
Required 9.

Do you have REC approval to issue samples to researchers without further formal ethics submission for individual studies?

Yes
No
  • Comment:

  • 500 characters left.
10.

If your biobank is located in England, Wales or Northern Ireland, what is your HTA licence number?
Please indicate whether the licence is held by your biobank directly or by a third party such as the university to which you are affiliated.
If you have no HTA licence (eg if your samples are collected as part of a REC-approved clinical trial) please indicate the reason for exemption.

 

350 characters left.
11.

If your biobank is located in Scotland, please provide details of your accreditation status. 

 

350 characters left.
12.

Is your Biobank licensed to curate samples for third parties? (eg clinical trials etc)

Yes
No
  • Comment:

  • 500 characters left.

Part III: Access to Samples

 
Required 13.

Do you have samples that are accessible currently by researchers throughout the UK?

Yes - open to applications at any time
Yes - open in response to specific calls
No - samples available but restricted to defined researchers or locations
No - samples unavailable for research as accrual planned or in progress
Other  
  • Comment:

  • 500 characters left.

Please ensure you provide a copy of your biobank's Access Policy to ccb@ncri.org.uk.

 
Required 14.

Who approves/will approve access by researchers to material from your Biobank?

 

350 characters left.
Required 15.

Please provide details of how your sample collection is advertised to potential applicants.

 

350 characters left.

Part IV: Declaration
Please note your biobank cannot be considered for full membership of CCB without the following commitments to the Confederation:

 
Required 16.

I confirm that our biobank complies with the CCB's Guiding Principles.

Yes
No (please provide reason below)
  • Comment:

  • 500 characters left.
Required 17.

I confirm that we will share information about our Biobank’s policies, procedures, operations and management with the CCB secretariat and other members of the Confederation.

Yes
No (please provide reason below)
  • Comment:

  • 500 characters left.
Required 18.

I confirm that as a member of the CCB we accept the terms of the Memorandum of Understanding?   

Yes
No (please provide reason below)
  • Comment:

  • 500 characters left.
Required 19.

I confirm that we have listed our Biobank in the NCRI Cancer Biosample Directory.

Yes
No (please provide reason below)
  • Comment:

  • 500 characters left.

Part V:  Your Membership of the CCB

 
Required 20.

Do you plan to participate in the CCB’s planned ‘quality mark’ scheme?

Yes
No (please provide reason below)
  • Comment:

  • 500 characters left.
21.

What benefits do you anticipate from your membership of the CCB?  (Please rank these in order of importance for your biobank)

 

350 characters left.
22.

What skills, interests and experience can you contribute to the CCB?

 

1000 characters left.
23.

Please tell us what strategic goals and practical developments you feel the CCB should pursue to improve the coordination of cancer biobanking in the UK.

 

1000 characters left.