If there are changes to the SMART IRB Agreement, do we need to re-execute the Joinder Agreement?

It will be determined, on an amendment-by-amendment basis, whether Participating Institutions must re-execute the Joinder Agreement.

In cases where a Participating Institution is unable to accept the terms of the amended Agreement, the institution may terminate its participation in SMART IRB, as described in the SMART IRB Standard Operating Procedure for "Ending Site Participation in SMART IRB or Specific Research."