Please carefully read the guidance on selecting the right subject area before completing the form. If after reading this you are still not sure which subject area to select, please select the 'not sure/don't know' from the drop down options.
To request an MHRA speaker for your event you must fill in all the details below. If you require multiple speakers for an event you will have to fill in the form for each speaker you wish to request.
* fields are required
Company name
*Title
*First name
*Surname
*Phone number
*Email address
*Confirm email address
*Postal address
*City
*Post code
*Country
*Are you submitting this form as a: --Select type of organisation or company-- Charity Government NHS University/College Information technology/telecommunications Pharmaceutical/Medical/Cosmetics Publishing/Media Retail/Wholesale/Import and export Professional conference organisers/event management Training provider Other (Please specify below)
*Name of event
*Date(s) of event
*Location of event
*Type of event --Select type of event-- Meeting Training programme Conference/seminar Other (Specify below)
Other (please specify)
*Expected number of attendees
*Type of audience Type of audience?
*Will the press be present?
Title of presentation
*Date of presentation
*Length of presentation (estimate)
*Subject area --Select subject area-- Chief executive or chairman Device technology and safety Information about and communicating with the MHRA Information management Inspection enforcement and standards Licensing of medicines Monitoring of medicines on the market Policies relating to medicines and medical devices Safe use of medical devices Not sure/don't know Selecting the right subject area
*Proposed content of presentation
Role of speaker --Select speaker role-- Question and answer host Panel chair Workshop host Lecturer/speaker Other (Specify below)
Other (Please specify)
Name of a preferred speaker (if known)
By submitting this form I agree that we are happy to cover the speaker’s travel, accommodation and any reasonable expenses if required. I also understand that a speaker fee may be applicable.
Please email speakers@mhra.gov.uk with any other relevant information or attachments