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Name:*

First Name Surname

Email Address:*

If you are using an NHS email as your username, please provide an alternative contact email address which will be used for all communication from the i2i Network and will guarantee receipt of our emails.

Alternative Email Address:

*required only if using NHS email as Username

Primary area of therapy interest:*

Current role

Country:*

County:*

Telephone Number:*

Practice / Organisation:*

Practice Postcode:*

Time in General Practice:

Do you have a GPhC/PSNI number?

Yes

GPhC/PSNI Number:*

Which IT system do you use?

Are you interested in speaking at future events?

Yes

Are you interested in facilitating in future workshops?

Yes

Are you a senior or clinical pharmacist?

Yes

Soar Beyond reserves the right to refuse membership applications in exceptional circumstances and to withdraw membership where deemed appropriate

Soar Beyond Ltd will only share information from carefully selected partners with you. This information will be targeted to your profile based on the interests that you have expressed and may be brought to your attention by a variety of means which includes, but is not limited to: bespoke emails and information within clinical bulletin emails.

You may opt out of receiving email communications by following the unsubscribe links provided in email communications.