Mounjaro  (Tirzepatide), Wegovy (Semaglutide) & Saxenda (Liraglutide): Registration Form for Webinar and PGD Training 
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Email *
Please fill-in your Order Confirmation reference number. * (Order  #XXXX) or put N/A if paid by training partners 
If you pay via alternative method or via training partners, please tell us how did you pay and the date of payment or name of training partners
Clinician First Name *
Clinician Last Name *
Mobile Number *
Your Profession *
Required
Professional Registration Number (e.g. GPhC, GMC, NMC) *
CQC or GPhC registered premises - Company name *
CQC or GPhC registered premises - Postcode *
Webinar Dates (Evening Webinar 8:00 pm to 9:30 pm) - a zoom link will be sent to you 24 hours before the training. If there is any issue, please contact our training coordinator on 02079932544. *
Please await confirmation via email. Please call 020 7993 2544 if you have not received a confirmation.
Required
I certify that the above facts are true to the best of my knowledge and beliefand I understand that I subject myself to professional conduct breach in the event thatthe above facts are found to be falsified.
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