Participant Registration

To participate in this event, please fill out the form below. A copy of the information you provide will be automatically sent to you by email after confirmation. For this first A3P event in Ireland, all Irish participants will receive one year of free membership with their registration (valued at 260 €).

Prices:

End-user Profile / Drug Manufacturer

- A3P Member : 190 €

- No A3P Member : 450 € (membership included)

Supplier Profile (Equipment & Product Saler or Service Provider, Consultant)

- A3P Member : 500 €

- No A3P Member : 760 € (membership included)

-----

You are:

Mr.

Mrs.

Last Name (in uppercase)

First name

Email address

Job function

Department service

Participant category

Company name (in uppercase)

Company address

Company City

Eirecode / Zip code

Country

Phone number

I'm signing up for the the NIBRT Facilities Tour (please note: space is limited, start at 4:30pm to 5:30 pm)Yes, I will take part in the tourNo, I will not take part in the tour

Do you have any food restrictions?

If you are human, ignore this field