<p> International Society of Pharmacovigilance Uppsala Monitoring Centre</p><p>Pharmacovigilance training: from surveillance to inspections 5th ISoP-UMC training course, 11-12 January 2018, Shenyang (China) venue: Hilton DoubleTree </p><p>APPLICATION FORM (Please complete the form – one form per person)</p><p>The cost for 2-day seminar (11 and 12 January 2018):  310 Euros (members of ISoP from China, Private sector e.g. Pharma, CRO, Private hospitals)  410 Euros (non members of ISoP from China, Private sector e.g. Pharma, CRO, Private hospitals) (includes one year’s ISoP membership to run until 31.12.2018)  155 Euros (members of ISoP from China, Public sector e.g. Academia, Authority, Public/military Hospitals)  240 Euros (non members of ISoP from China, Public sector e.g. Academia, Authority, Public/military Hospitals) (includes one year’s ISoP membership to run until 31.12.2018)  410 Euros (members of ISoP, Private sector e.g. Pharma, CRO, Private hospitals, HIC countries*)  650 Euros (non members of ISoP, Private sector e.g. Pharma, CRO, Private hospitals, HIC countries*) (includes one year’s ISoP membership to run until 31.12.2018) (*) HIC (High Income) countries – outside China- include Hong Kong, Taiwan, Macao, Singapore, Brunei, Korea, Japan, Australia, New Zealand, Canada, USA, Israel, EU/AELE, Bahrain, Qatar, Saudi Arabia, Kuwait, Oman, UAE</p><p>The cost includes lunch, coffee breaks but does not include accommodation, dinner or travel. Information on hotels in Shenyang available from the ISoP Administration office or website (isoponline.org) Payments (payments must be net of bank charges):</p><p> Bank transfers to: NatWest bank, Uxbridge branch – 48 High Street, Uxbridge, Middlesex UB8 1UT – UK - Account No: 68010788 - IBAN: GB93 NWBK 6072 0668 0107 88 - BIC/SWIFT: NWBK GB 2L Payable to: International Society of Pharmacovigilance (ISoP). Please quote your surname/TC - on the transfer and send a copy of the bank transfer form with the application form to ISoP. Payments must be net of bank charges.  Credit-Debit Card | Payment Online. To start using online registration payment go to www.isoponline.org (under ‘ISoP UMC Training’) and follow the on-screen instructions. AMEX, VISA, and MasterCard accepted. Please note, when paying with a credit card, 6 euros will be added to cover bank charges to ISoP. Title: Mr | Ms | Dr | Prof ISoP Member? YES | NO Last Name: First Name: Organisation: Address:</p><p>Country: Job title: Phone | Fax: E-mail: @ Any dietary or other special requirements? Which hotel are you staying in? Date: Signature: Please complete and send this form and payment before 11 January 2018 to: International Society of Pharmacovigilance Uppsala Monitoring Centre</p><p>International Society of Pharmacovigilance-ISOP Secretariat Ltd, 140 Emmanuel Road, London SW12 0HS, UK Telephone and fax: +44 (0)20 3256 0027 E-mail: [email protected] – www.isoponline.org Cancellations must be received in writing. Cancellation notice should be advised at least prior to 13 November 2017 otherwise no refund will be applied. By completing this registration form you are agreeing to ISoP’s cancellation policy. Current members of ISoP are eligible for “member” rate. If ISoP cannot verify your current membership, you will be charged the Non-member rate. The course will start on 11 January at 08.30 through to 17.30 and continue on 12 January at 08.30 through to 17.15. An acknowledgement with information will be e-mailed within one week of our receiving payment.</p>