PCP On-site attendance

Contact Details

Title

First Name

Last Name

Organization

Email Address

Additional Emails

City

Country

Mobile Phone

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Emergency contact details

In case of an emergency, please provide the contact details of a person* we can reach:
* Your emergency contact may not have the legal authority to act on your behalf unless you explicitly provide that power

Full Name of Emergency Contact

Relationship to You

Phone Number (including country code)

Email Address

PRESCRIBER / NON-PRESCRIBER

Support from pharmaceutical partners helps make this event possible. As such, it is important that we comply with the various codes and directives relating to the manufacturing, distribution, and marketing of pharmaceutical products. The European Union directive (2001/83/EC, article 86) provides guidelines relating to medicinal products for human use. Within these guidelines is the restriction that access to pharmaceutical product marketing activities must be limited to only those participants licensed/authorised to prescribe or supply medicinal products. All participants, with the exception of the exhibitors, are asked the following question during registration: Are you licensed/authorised to prescribe or supply prescription only medicines?

Are you licensed/authorised to prescribe or supply ‘prescription medicines’? ("P" - Prescriber, N/P - Non-Prescriber)

I agree that my contact details be shared with sponsors and exhibitors of this event so that they may contact me regarding events, news & information on their products.

Note: Notwithstanding the above, please note that if you present your delegate badge to be scanned by an exhibitor or sponsor representative, you are sharing your personal information with them.

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Invoice Details

Company Name

Invoice Address Line 1

Invoice Address Line 2

Invoice Address Line 3

Invoice Address City

Invoice Address Country

Invoice Address State

Invoice Address Line ZIP/Post

VAT

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PCP On-site attendance

PRESCRIBER / NON-PRESCRIBER

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