Western Human Nutrition Research Center : Recruitment Form

To receive information about future research studies, please provide the following information.

You will be contacted by recruitment staff.

To mail the form using USPS, use the “ printable version” link at the top of the page and mail your form to us at the following address.

Western Human Nutrition Research Center

University of California, Davis

Attn: Recruitment Office

430 West Health Sciences Drive

Davis, CA 95616

To submit by email, * information required:

First Name*

Middle Name

Last Name*

Email*

Address

City

State

Zip code

Cell/Home Phone*

Work Phone

Age*

Sex*

Male Female

Subject

Study of Interest or Additional Comments

OMB 0518-0032 (09/2012)

According to the Paperwork Reduction Act of 1995, an agency cannot conduct or sponsor, and a person is not required to collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0518-0032. The time required to complete this information is estimated to vary from one to five minutes with an average of three minutes per response, including time for reviewing instructions, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Agriculture, Clearance Officer, OIRM, Room 404-W, Washington, DC 20250, and to the Office of Information and Regulatory Affairs, Office of Management and Budget.

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