Chiesi F2F 2022 - Workshop Detail Form

Chiesi F2F 2022 – Workshop Detail Form

Please complete this form at your earliest convenience. We will then progress the booking and confirm full details, including the unique link and payment code for your invitation.

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-2201727 Date of Preparation: July 2022

Chiesi F2F 2022 - Workshop Detail Form

Please complete all sections of this form at your earliest convenience. We will then progress the booking and confirm full details, including the unique link and payment code for your invitation.

Name of Chiesi Representative(Required)

First Last

Email(Required)

Mobile Phone(Required)

Chiesi Region(Required)

Regional Manager(Required)

Confirmed Date of Workshop(Required)

Confirmed Venue(Required)

Venue Address

Address Line 1 Address Line 2 Town/City County / State / Region Post Code

Meetng Room Name/Location

Venue Contact Name(s)(Required)

Venue Contact Phone(Required)