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/[a-zA-z]{1}[0-9]{3}$/

/^\d{5}$/

/^((0?[1-9])|([1-8][0-9])|(9[0-8]))[0-9]{3}$/

/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))$/

/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))$/

/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))$/

/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31)))) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/

/^(?!\.)((?!.*\.{2})[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)(\.[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)*@(?!\.)([a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF\-\.\d]+)((\.([a-zA-Z\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF]){2,63})+)$/i

/^([_a-z0-9-']+)([.+][_a-z0-9-']+)*@([a-z0-9-]+)(\.[a-z0-9-]+)*(\.[a-z]{2,12})$/

/^(?:\d[a-zA-Z]\d)$/i

/^(?:[a-zA-Z]\d[a-zA-Z])$/i

/^([_a-z0-9-\']+)([.+][_a-z0-9-\']+)*@([a-z0-9-]+)(\.[a-z0-9-]+)*(\.[a-z]{2,4})$ |@(?!gmail)(?!yahoo)(?!hotmail)(?!msn)(?!facebook)(?!live)(?!outlook)/

/^[-+]?\b\d+\b$/

/^[a-z]+$/i

/^\d{10}$/

/^[a-z0-9-_]+$/i

/^[-+]?[0-9]*\.?[0-9]+([eE][-+]?[0-9]+)?$/

/^-?\d+,\d$/

/^-?\d+\.\d$/

/^\d{10}$/

/^-?\d+,\d{2}$/

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/^(?:[1-9]|[1-4][0-9]|[5][0]|\d{1})(?:\.\d{1})?$|^999$/

/^([1-9][0-9](\.\d{1,3})?%?$|[1][0-4][0-9](\.\d{1,3})?%?$|150$|999$)/

/^([1-9][0-9](\.\d{1,3})?%?$|[1][0-9][0-9](\.\d{1,3})?%?$|200$|999$)/

/^($0[2-8]$|0[2-8])\s*\d{4}\s*\d{4}$/

/^(?:$?([2-9]0[1-9]|[2-9]1[02-9]|[2-9][2-9][0-9]|800|811)$?)\s*(?:[.-]\s*)?([2-9]1[02-9]|[2-9][02-9]1|[2-9][02-9]{2})\s*(?:[.-]\s*)?([0-9]{4})(?:\s*(?:#|x\.?|ext\.?|extension)\s*(\d+))?$/

/^\d{4}$/

/^[ABCEGHJKLMNPRSTVXY]{1}\d{1}[A-Z]{1}\s*\d{1}[A-Z]{1}\d{1}$/i

/^(0[1-9]|[1-9]\d)\d{3}$/

/^\d{3}-\d\d-\d{4}$/

/^([0-9]|[0-1][0-9]|[2][0-3]):([0-5][0-9]):([0-5]\d)$/

/^([0-9]|[0-1][0-9]|[2][0-3]):([0-5][0-9])$/

/^[0-5]\d:[0-5]\d$/

/^[0-9]{4,9}$/

/^\d{5}(-\d{4})?$/

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Pediatric Sepsis Data CoLaboratory Membership Application

Thank you for your interest in joining the Peditaric Sepsis Data CoLaboratory (Sepsis CoLab). Please complete the membership application below.

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Institution

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Profession

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9.1

Please specify:

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10.

What WFPICCS member organizations are you affiliated with (if any)? (Select all that apply)

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AAP - American Academy of Pediatrics

ACCCN - Australian College of Critical Care Nurses

ACOPE - Asociacion Costarricense de Pediatria - Capitulo: Medicina Critica y Cuidados Intensivos

AEPC - Association for European Paediatric Cardiology (Working Group on Paediatric Cardiac Intensive Care)

African Paediatric Critical Care Association

AMIB - Associacao de Medicina Intensiva Brasileira - Departamento de Pediatria

AMIETIP - Academy of Medical and Nursing Emergency and Pediatric Intensive Care

AMTIP - Asociacion Mexicana de terapia Intensiva Pediatrica, AC

ANZICS - Australian and New Zealand Intensive Care Society

Asociacion Colombiana de medicina Critica y Cuidado Intensivo

Asociacion de terapia Intensiva Pediatrica de Centroamerica y El Caribe

CACCN - Canadian Association of Critical Care Nurses

CCAC - Cameroon Critical Care Nurses Association

CCSSA - Critical Care Society of Southern Africa

CEM - The Assembly of Pediatric Emergency and Intensive Care of Chinese Pediatric Society

CPPC - College of Pediatric Critical Care (India)

EPNMS - Emirates Pediatric Neonatal Medical Society

ESNPC - The Egyptian Society for Neonatal and Preterm Care

ESPIC - The Egyptian Society of Pediatric Intensive Care

ESPNIC - European Society Pediatric and Neonatal Intensive Care

GFRUP - Groupe Francophone de Reanimation et Urgences Pediatriques

IAP - Intensive Care Chapter of Indian Academy of Pediatrics

IPACCS - Irish Paediatric Anaesthesia and Critical Care Society

IPS - Indonesian Pediatric Society (Pediatric Emergency and Intensive Care Working Group (PEIC WG)

IPSS - International Pediatric Simulation Society

ISCCM - Pediatric Section of the Indian Society of Critical Care Medicine

JSPICC - Japanese Society of Pediatric Critical Care

KSPCCM - Korean Society of Pediatric Critical Care Medicine

MSIC - Malaysian Society of Intensive Care

NZCCCN - New Zealand College of Critical Care Nurses

PCICS - Pediatric Cardiac Intensive Care Society

Pediatric Chapter of the Saudi Critical Care Society

PICS - The Paediatric Intensive Care Society

Portuguese Society of Paediatrics- Intensive Care Chapter

PSG - Pediatric Society of Ghana

SARNePI - Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care

SATI - Sociedad Argentina de Terapia Intensiva

SBP - Sociedade Brasileira de Pediatria - Departamento de Terapia Intensiva

SCCM - Society of Critical Care Medicine

SECIP - Sociedad Chilena de Cuidado Intensivo Pediatrico

SECIP - Sociedad Espanola de Cuidados Intesivos Pediatricos

SIAATIP - Italian Society of Anesthesia, Analgesia and Pediatric Intensive Care

SLACIP - Sociedad Latino Americana Cuidados Intensivos Pediatricos

Sociedad Ecuatoriana de Cuidado Intensivo Pediatrico

Sociedad Paraguaya de Cuidados Intensivo Pediatricos y Neonatales

Society of Intensive Care Medicine (Singapore)

SPCCMP -Society of Pediatric Critical Care Medicine Philippines

SPEICM - Society of Pediatric Emergency and Intensive Care Medicine (Turkey)

Sri Lankan Society for Critical Care and Emergency Medicine

SUNPI - Sociedad Uruguayade Neonatologia y Pediatria Intensiva

SVMC - Sociedad Venezolana de Medicina Critica

TPRC - Thai Pediatric Respiratory and Critical Care Society

TSPICCM -Taiwan Society of Pediatric Intensive and Critical Care Medicine

I AM NOT AFFILIATED WITH ANY OF THE LISTED SOCIETIES/ASSOCIATIONS

10.1

What is the name of your organization? (if applicable)

11.

What are your research interests, particularly those in which you are hoping to collaborate with the CoLab?

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12.

What motivated you to join the Pedatric Sepsis CoLab?

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13.

How did you hear about us?

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13.1

Please specify:

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14.

Have you created a Scholars Portal Dataverse account?

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Yes

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Please create an account Here

(1 min. application form)

15.

Scholars Portal Dataverse username:

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Forgot your Dataverse username? Click the link below for 2-step instructions on how to retrieve it.

Attachment:

Retrieve Dataverse username.jpg

As a member of the Pediatric Sepsis CoLaboratory, you must agree to our Memorandum of Understanding. Please review the attached form.

Attachment:

Pediatric Sepsis CoLaboratory Memorandum of Understanding.08.07.2020.pdf

16.

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I agree to the Memorandum of Understanding.

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17.

Date of agreement:

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M-D-Y

18.

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I confirm that the information given in this form is true, complete and accurate.

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