Application for Registration Support

Please follow the registration process and complete as many details as possible using English characters only
Should you be unable to complete this form, please contact us: reg_ipvc21@kenes.com

Contact Details

Title

First Name

Last Name

Email Address

City

Country / Areas

Mobile Phone

Please write a short paragraph about why you want to be included for this grant and how this conference can be beneficial for you?

Additional Information

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’?

Within the virtual event platform healthcare professional authorised to prescribe prescription medicines will be recognized with a letter P (Prescriber) indicated after their names.

I would like to be considered for this registration support and I am fully aware that submitting this form does not mean I am automatically selected to receive the support.

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, if you present your participant badge for scanning by representatives of sponsors or exhibitors, or by clicking on “Badge Swipe/Scan my badge” button or “Contact Me” link, you are sharing your personal information with them to be used for statistical purposes and for future communication with you.

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