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PHARMACEUTICAL COMPANY SPONSORSHIP FORM

Please complete the following form, and click on "Send Application".
Name:
Company:
Tel No:
Email:
I am a:
GP Rep Hospital Rep Both
Product Areas or Services:
Target Audiences:
Would you be prepared to sponsor a GP meeting where other sponsors (not in competition with yourself) were present?
No Yes
Lecture content - is it vital that the lecture content is relevent to your product(s) or would you be interested in coming along to meet GPs/Consultants and network?
Content must be relevent Happy to just network
Please state the geographical areas in which you are interested:
Team: