NPA Leadership training enrolment form

Please note: that this enrolment form is for NPA members, if you are currently not in membership with the NPA, please initially contact our Member Services team on 01727 800402.

Student details for NPA Leadership training

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Full Name

Name*

Prefix First Last

Date of birth*

Email address*

Please ensure this email address is unique to the student, we will use this for the purpose of contacting them with login details to the eLearning platform to access the webinar training.

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Telephone number*

Supervisor/Supervising pharmacist details

NPA Member No:

Supervisor/Supervising pharmacist Full Name*

GPhC No*

Supervisor/Supervising pharmacist Email Address*

Please ensure this email address is not shared and is unique to the supervising pharmacist, we will use this for the purpose of sending them login details to access the eLearning platform and the Leadership training, if applicable.

Supervisor/Supervising pharmacist Telephone Number*

I can confirm that:*

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I am a permanent supervisor of the student
I am willing to support the student throughout the training
I have carried out a personal assessment of the student's capabilities

Pharmacy Name*

Pharmacy Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about this course*

If other please provide more details

Important Information

Data Protection Notice

It is important that you understand how the personal information you give us will be used. Therefore, we strongly advise that you read our Privacy Statement, which you can find at Privacy Notice.

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Terms of Service*

Read our full Terms and Conditions here.

I agree to the Terms of Service

Comments

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