2025 Reg Form – Test Page | ephmraconference

2025 Reg Form – Test Page

- Step 1 of 3

Name *

First

Last

Job Title *

Mobile Phone *

Company Name *

Email *

City you live in *

Are you attending as a delegate

I will be attending as a delegate
I won't be attending as a delegate

Tuesday 24 June Welcome Drinks: 18.00 - 19.30 *

YES I will be attending
NO I won't be attending

Wednesday 25 June Evening event: 18.30 - 22.30 *

YES I will be attending
NO I won't be attending

Catering : We will always ensure that there is a vegetarian option. If you have any other dietary restrictions please let us know by selecting the relevant options if applicable:

Vegan
Vegetarian
Nut Allergy
Gluten free and coeliac
Dairy or lactose free
Shell fish

Other: Please state

Delegate 1

Name *

First

Last

Job Title *

Mobile Phone *

Email *

City you live in *

Tuesday 24 June Welcome Drinks: 18.00 - 19.30 *

YES I will be attending
NO I won't be attending

Wednesday 25 June Evening event: 18.30 - 22.30 *

YES I will be attending
NO I won't be attending

Catering : We will always ensure that there is a vegetarian option. If you have any other dietary restrictions please let us know by selecting the relevant options if applicable:

Vegan
Vegetarian
Nut Allergy
Gluten free and coeliac
Dairy or lactose free
Shell fish

Other: Please state

At the evening event on Wednesday 25 June the main courses will be based on a meat or vegetarian option. Please let us know if you would prefer a vegetarian option as this needs to be pre-booked for you. We will also take any dietary requirements from the previous question into consideration.

Meat
Vegetarian

Delegate Details

You can add up to 5 delegates. Please provide the details of the delegates attending. Name changes can be made - so check the Conference T&Cs as to when this can be done free of charge.

Delegate 2

Click to add delegate 2

Delegate 2

Name *

First

Last

Job Title *

Mobile Phone *

Email *

City you live in *

Tuesday 24 June Welcome Drinks: 18.00 - 19.30

YES I will be attending
NO I won't be attending

Wednesday 25 June Evening event: 18.30 - 22.30

YES I will be attending
NO I won't be attending

Catering : We will always ensure that there is a vegetarian option. If you have any other dietary restrictions please let us know by selecting the relevant options if applicable:

Vegan
Vegetarian
Nut Allergy
Gluten free and coeliac
Dairy or lactose free
Shell fish

Other: Please state

Meat
Vegetarian

Delegate 3

Click to add delegate 3

Delegate 3

Name *

First

Last

Job Title *

Mobile Phone *

Email *

City you live in *

Tuesday 24 June Welcome Drinks: 18.00 - 19.30

YES I will be attending
NO I wont be attending

Wednesday 25 June Evening event: 18.30 - 22.30

YES I will be attending
NO I won't be attending

Catering : We will always ensure that there is a vegetarian option. If you have any other dietary restrictions please let us know by selecting the relevant options if applicable:

Vegan
Vegetarian
Nut Allergy
Gluten free and coeliac
Dairy or lactose free
Shell fish

Other: Please state

Meat
Vegetarian

Delegate 4

Click to add delegate 4

Delegate 4

Name *

First

Last

Job Title *

Mobile Phone *

Email *

City you live in *

Tuesday 24 June Welcome Drinks: 18.00 - 19.30

YES I will be attending
NO I wont be attending

Wednesday 25 June Evening event: 18.30 - 22.30

YES I will be attending
NO I won't be attending

Catering : We will always ensure that there is a vegetarian option. If you have any other dietary restrictions please let us know by selecting the relevant options if applicable:

Vegan
Vegetarian
Nut Allergy
Gluten free and coeliac
Dairy or lactose free
Shell fish

Other: Please state

Meat
Vegtarian

Delegate 5

Click to add delegate 5

Delegate 5

Name *

First

Last

Job Title *

Mobile Phone *

Email *

City you live in *

Tuesday 24 June Welcome Drinks: 18.00 - 19.30

YES I will be attending
NO I won't be attending

Wednesday 25 June Evening event: 18.30 - 22.30

YES I will be attending
NO I won't be attending

Catering : We will always ensure that there is a vegetarian option. If you have any other dietary restrictions please let us know by selecting the relevant options if applicable:

Vegan
Vegetarian
Nut Allergy
Gluten free and coeliac
Dairy or lactose free
Shell fish

Other: Please state

Meat
Vegetarian

Payment Method

Credit Card - Debit Card
BACS Payment

We send a credit card link and this must be paid within 5 working days. If the fee is not paid within 5 working days then the registration will be cancelled.

Registration Fees:

Fees – for Agency Member Companies

One ticket for one delegate: GBP 2,619.40 + 20% VAT = GBP 3,143.28
2 delegate tickets: GBP 5,238.78 + 20% VAT = GBP 6,286.54
3 delegate tickets: GBP 7,196.43 + 20% VAT = GBP 8,635.72
5 delegate tickets: GBP 11,718.34 + 20% VAT = GBP 14,062.00

Fee for Industry Members

One ticket for one industry member delegate: GBP 1,039.50 + 20% VAT = GBP 1247.40

Young Professionals Ticket

I would like 1 young professionals ticket: GBP 1,039.50 + 20% VAT = GBP 1247.40

*Must have been working in healthcare market research for under 5 years, have a title that is Associate Director and below.

Fees – for Non Member Companies (Industry and Agency)

One ticket for one delegate: GBP 3,998.02 + 20% VAT = GBP 4,797.63
3 delegate tickets: GBP 10,339.71 + 20% VAT = GBP 12,407.65

Ticket Restrictions:

If multiple tickets are booked at different times, the discount will not apply.
No place sharing is possible. One delegate = one ticket.
No day tickets are available sorry.

Billing Address *

Please let us know your Billing/Address for the invoice:

Once we have received your registration we will be in touch within 2 working days with:

Any clarification needed
Sending the invoice
Credit Card Link

Terms & Conditions:

YOU CAN FIND OUR TERMS AND CONDITIONS HERE

T&C's

Tick here to confirm you have read the Terms & Conditions of Booking