Chiesi F2F 2022 - Provisional Booking Form

Chiesi F2F 2022 – Provisional Booking Form

Thank you for requesting a Chiesi Face2Face Workshop. Please complete the details below at your earliest convenience. Once this information is received, Education for Health will liaise with our course facilitators to confirm availability. We hope to be able to get back to you within 10 working days.

DISCLAIMER

This educational programme is funded by Chiesi Ltd. The educational content is developed and delivered by Education for Health. For the avoidance of doubt Chiesi neither seeks nor expects you or those with whom you practice to promote the administration, consumption, prescription, purchase, recommendation, sale, supply or use of any Chiesi medicinal products in connection with the funding here provided for.

UK-RES-2201725 Date of Preparation: July 2022

Chiesi F2F 2022 - Provisional Booking Form

Form to be completed by Chiesi Representative to request a F2F Workshop

Name of Chiesi Representative(Required)

First Last

Email(Required)

Mobile Phone(Required)

Chiesi Region(Required)

Regional Manager(Required)

Proposed Date of Workshop - week commencing(Required)

Proposed Location - town/city(Required)