PUP form – Register your interest

Registering interest - Pharmacy undergraduate programme

Are you registering as a :
- Student
- Supervising Pharmacist
Student details
Please fill out the details below
Title
First name
Surname
Date of birth
MM slash DD slash YYYY
Email address*

Please ensure this email address is unique to you, we will use this for the purpose of contacting you
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name of university
Have you already completed your placement
- Yes
- No
Supervising Pharmacist details:
Please fill out the details below
Please confirm that you are enrolling a student
- Yes, I confirm that I have a student
Please fill out your student's details above
Title
First name
Surname
NPA member no.
GPhC no.
Email address*

Please ensure this email address is not shared and is unique to the pharmacist, we will use this for the purpose of emailing login details
Telephone number
Fax number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Important Information
Please ensure this email address is not shared and is unique to the pharmacist, we will use this for the purpose of emailing login details. Remember to check your junk mail box or add the NPA to your contacts in order to ensure that our emails arrive in your inbox.
CAPTCHA
How we will use your data*
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.
- I agree to the Terms of Service
Phone
This field is for validation purposes and should be left unchanged.

PUP form – Register your interest

Registering interest - Pharmacy undergraduate programme

Student details

Supervising Pharmacist details:

Important Information

Data Protection Notice