Pharma Marketing Network Roundtable Membership Request Form

1. Intro and Opt-In

Your personal information will be held confidential and will not be shared with or sold to third parties except as noted in each question where we ask for information. NOTE: You must provide your organization's legal name and your job title to verify that you are a professional. Your email address is used by the system administrator to contact you about this application and notify you of new Roundtable topics. Your application will be rejected if this information is not complete.

1. Do you agree to accept periodic e-mail notices from the system administrator sent to the e-mail address you provide in this form? These messages notify you of the status of your Roundtable application and, if you become a member, about topics posted that are in your interest area. Other Roundtable notices may also be sent to you by email periodically. No other use will be made of your e-mail address and no other member or the Forums or online public will have access to your e-mail address or be able to contact you via e-mail UNLESS you allow this by modifying your profile at a later date. If you answer "No", you will exit this form and no personally-identifiable data will be collected or maintained.

Do you agree to accept periodic e-mail notices from the system administrator sent to the e-mail address you provide in this form? These messages notify you of the status of your Roundtable application and, if you become a member, about topics posted that are in your interest area. Other Roundtable notices may also be sent to you by email periodically. No other use will be made of your e-mail address and no other member or the Forums or online public will have access to your e-mail address or be able to contact you via e-mail UNLESS you allow this by modifying your profile at a later date. If you answer "No", you will exit this form and no personally-identifiable data will be collected or maintained. Yes