Participant Sign-Up Form

I grant permission to the Centre on Aging and Health, University of Regina to include my name, age and the contact information listed below in its Directory of Potential Research Participants. In doing so, I understand that I may be contacted by researchers involved in aging and/or health research.  Access to the directory will only be given to persons who have a formal affiliation with the Centre on Aging and Health.  I also understand that I can arrange for my name to be withdrawn from the directory at any time by contacting the Centre on Aging and Health (Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2) or the Directory Coordinator directly ( (306) 337-8477, cah@uregina.ca).  Moreover, I understand that each time I am contacted and asked to participate in research, details of the specific project will be provided to me before I give my consent. I have the right to refuse participation or withdraw from any study at any time without penalty.