online application form


29 January 2020

13th Pharmacovigilance Conference

HILTON HOTEL, AMSTERDAM

Apollolaan 138, NL-1077 BG Amsterdam

30-31 JANUARY 2020

19th Regulatory and Scientific Affairs Conference

HILTON HOTEL, AMSTERDAM

Apollolaan 138, NL-1077 BG Amsterdam

REGISTER FOR BOTH THE 13th PHARMACOVIGILANCE CONFERENCE AND
THE 19th REGULATORY AND SCIENTIFIC AFFAIRS CONFERENCE AND GET A 10% DISCOUNT!

On receipt of your on-line form, your registration will be confirmed within 5 working days and sent to the e-mail address provided in this application form. The invoice will be sent separately in January 2020. Please note that the e-mail address provided may also be used for distribution of any conference material and information (programme updates etc.).

By attending the event, you give permission for images of you, captured during the conference through video, photo, and/or digital camera, to be used by Medicines for Europe in promotional materials, publications, and website and waive any and all rights including but not limited to compensation or ownership.

If the e-mail confirmation is not received within 5 working days please contact Lucia Romagnoli

A list of participants including your name, company, country and website will be sent to the other delegates 7 days before the event and may be included in the event documentation.

The official language of the event is English (no translation is available).

It may be necessary, for reasons beyond the organisers' control, to alter the dates, venue, timing and content of the programme (including speakers) without prior notice. The organisers regret that they cannot accept liability for losses incurred by delegates in these circumstances.

Title
First Name
Family Name
Company
Job Title
Company VAT No.
Company Invoice Address
Postal Code
City
Country
Tel No.
E-mail
Please, retype your E-mail for confirmation
Assistant E-mail
Website

You can register separately for:
- the 13th Pharmacovigilance Conference (go to point 1).
- the 19th Regulatory and Scientific Affairs Conference (go to point 2).

If the same delegate registers for all three days (13th Pharmacovigilance Conference + 19th Regulatory and Scientific Affairs Conference) a discount of 10% of the total fee will be automatically applied.

If you wish to register more than one delegate from the same company/association please complete one form per delegate.

1. Register for the 13th Pharmacovigilance Conference (29 January 2020)


€ 514,25 (€ 355+21% NL VAT on Event Fee and € 77,71+9% NL VAT on Catering Fee)*. Please note that the organisers reserve the right to accept these registrations and a full fee might be applied.

My Company/Association is a Member of one of the three sector groups of Medicines for Europe and I will pay the a Total Member Fee of € 1222,10 (€ 940+21% NL VAT on Event Fee and € 77,71+9% NL VAT on Catering Fee)*

My Company/Association is NOT a Member of Medicines for Europe and I will pay a Total Non-Member Fee of € 1512,50 (€ 1180+21% NL VAT on Event Fee and € 77,71+9% NL VAT on Catering Fee)*

EXHIBITION TABLE**: My Company/Association is a Member of one of three sector groups of Medicines for Europe and I will pay the Exhibition Table Member Fee of € 1770 (VAT reverse charge for VAT registered entities)

EXHIBITION TABLE**: My Company/Association is NOT a Member of the Medicines for Europe and I will pay the Exhibition Table Non-Member Fee of € 1915 (VAT reverse charge for VAT registered entities)

EXHIBITION STAFF***: My Company/Association has registered for an exhibition table and I wish to register as EXHIBITION TABLE STAFF MEMBER* at a Total cost of € 217,80 (€ 110+21% NL VAT on Event Fee and € 77,71+9% NL VAT on Catering Fee)*

No, I do not want to register for the 13th Pharmacovigilance Conference

2. Register for the 19th Regulatory and Scientific Affairs Conference (30 - 31 January 2020)


. Please note that the organisers reserve the right to accept these registrations and a full fee might be applied.

My Company/Association is a Member of one of the three sector groups of Medicines for Europe and I will pay a Total Member Fee of € 1996,50 (€ 1470+21% NL VAT on Event Fee and € 199,82+9% NL VAT on Catering Fee)*

My Company/Association is NOT a Member of Medicines for Europe and I will pay a Total Non-Member Fee of € 2504,70 (€ 1890+21% NL VAT on Event Fee and € 199,82+9% NL VAT on Catering Fee)*

EXHIBITION TABLE**: My Company/Association is a Member of one of the three sector groups of Medicines for Europe and I will pay the Exhibition Table Member Fee of € 3285 (VAT reverse charge for VAT registered entities)

EXHIBITION TABLE**: My Company/Association is NOT a Member of Medicines for Europe and I will pay the Exhibition Table Non-Member Fee of € 3845 (VAT reverse charge for VAT registered entities)

EXHIBITION STAFF***: My Company/Association has registered for an exhibition table and I wish to register as EXHIBITION TABLE STAFF MEMBER* at a Total cost of € 375,10 (€ 130+21% NL VAT on Event Fee and € 199,82+9% NL VAT on Catering Fee)*

No, I do not want to register for the 19th Regulatory and Scientific Affairs Conference or I am already registered as a speaker at this Conference

* VAT Reverse charge for NL VAT registered entities. Please make sure that your full NL VAT number (starting with NL) is included in the form when submitting.
** EXHIBITION TABLE: The price for an exhibition table includes 1 entrance to the conference, 1 table and 2 chairs in the foyer area where you can present your company material during networking breaks.
*** EXHIBITION STAFF REGISTRATION does not include entry to the conference but only to the exhibition area + networking events.

2B. REGISTER FOR PART OF THE 13th PHARMACOVIGILANCE CONFERENCE ON THE 29 JANUARY 2019 FROM 14.00-17.30


I AM REGISTERED FOR THE 19th REGULATORY AND SCIENTIFIC AFFAIRS CONFERENCE AND on the 29 January 2019 I wish to attend:

the 13th Pharmacovigilance Conference from 14.00-17.30 at a cost of € 265 (+21% VAT) = € 320,65

Method of payment


Please note: all fees are in Euro and include coffee breaks, buffet lunch(es) during the events and the Conference dinner on 30 January 2020 (only for delegates of the 19th Regulatory and Scientific Affairs Conference). Fees do not include any refreshments/beverages not offered as part of the event for which you are registered. Travel & accommodation are your own responsibility. Meals requiring special preparation (such as Kosher) may incur additional costs.

Payment must be received in Euro before the event and bank charges are your own responsibility. The VAT invoice will be sent via e-mail in January 2020 and only once the payment has been received.

CANCELLATION POLICY: All cancellations must be received in writing 21 calendar days prior to the start of the event and will be subject to an administration fee of 150 Euro. For cancellation after this time, or if the delegate fails to attend the event, no refund of fees may be expected and the amount of the invoice is due. Substitutions are welcome at no extra charge but ONLY until 25 January 2020. The organisers reserve the right to cancel the event at any time without liability. In these circumstances, delegates will be offered an alternative date, a credit note or a full refund.

Registrations close officially on 23 January 2020 and are subject to availability.

We remind you that the organisers are not responsible for your travel and stay.

Under which category do you wish to be registered?



Academics/Students

Analysts/Consultants/Investors

Authorities

CROs/Service Providers

Legal Firms

Industry

HCP Practice/Hospital

Patients/Consumers/NGOs

Press

Others, please specify:

Where did you hear about this event?



Ad in Scrip Pharmaceutical News

Ad in Generics Bulletin

Ad in another publication, please specify:

Event Flyer

Colleague

E-mail Ad

Twitter, Linkedin

E-mail from Medicines for Europe

Via a generic/biosimilar medicines association, please specify which one:

Other, please specify:



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