Membership Application

Thank you for your interest in joining the INNODIA Network. Please complete this application to request Membership. We will review your submission and get back to you with the next steps.

Fields marked with * are required.

Thank you — your membership application has been submitted.
We have received your information. You will be redirected to www.innodia.org in a few seconds.

Information on the Organization

Please provide the following information on your Organization.

Research hospital, University, Medical center, Non-profit, Patient organization, SME, etc.

Type of Membership Requested

Please select only one (see the explanatory document for the rights and obligations of each Membership type).

Organization’s Representative

Please provide the following information on the person representing the Organization and submitting this application.

Pick your country from the flag dropdown — the dial code is added automatically.

One per line, in the format Full Name ; Role ; Email.

Role(s) to Play in the Network

Please select all that apply. Tick a category to apply, then add up to 2 reference contacts for it.

Clinical sites in INNODIA are healthcare centers providing care to people with T1D of any age and at any stage of the disease, in one or more of these roles:

  • Referral & Outreach Site (Core Level) – committed to identifying and referring eligible patients to nearby INNODIA trial centers.
  • Clinical Trial Site – involved in running clinical trials with life-changing therapies.
  • Early Detection Site – contributing to early identification of T1D patients through the INNODIA screening program.

One per line, in the format Full Name ; Role ; Email.

Research & Mechanistic Laboratories – focus on understanding the fundamental biological processes that lead to T1D.

Pre-clinical Laboratories – evaluate safety and efficacy of therapeutic compounds before human testing.

Accredited laboratories (e.g. ISO 15189) performing validated diagnostic tests relevant to T1D.

One per line, in the format Full Name ; Role ; Email. Applies to both Labs and DxLabs.

Patient Organizations (POs) as members of INNODIA are legal entities dedicated to people living with Type 1 Diabetes — providing day-to-day support, sustaining research and other activities. They commit to contribute to the acceleration of medicine development for T1D through INNODIA.

One per line, in the format Full Name ; Role ; Email.

Additional Information

Date and Location

Privacy & Communication Preferences

By submitting this form, you consent to the use of your data and those of the listed contacts for Membership purposes under the GDPR (INNODIA — Membership Privacy Policy).

Please read the information carefully regarding how INNODIA may contact you (Symposiums, Network Events (Event Privacy Policy), further training opportunities, “Tuesdays with INNODIA” and INNODIA’s Newsletter (Website and Newsletter Privacy Policy)).