EPSA Alumni Contact Update
We would kindly thank you for taking the time to complete this questionnaire about your current contact details. We will update your details if you have already informed us previously, and amend any changes that you share with us. Feel free to update this form at any point throughout the year when you know that your information changes, such as contact information, job, etc.In EPSA we would like to remain in contact with those former colleagues from each mandate, past officials of EPSA, with the intention to create opportunities to engage with current students of Pharmacy in Europe. We appreciate your work and hope we can stay in touch.
Name
*
First Name
Last Name
Country of residence
*
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Email
*
example@example.com
Facebook link to profile
*
LinkedIn link to profile
*
Twitter link to profile
*
Skype name
*
Involvement in EPSA:
*
EPSA Team Member
Liaison Secretary
National IMP Coordinator
EPSA Trainer
EPSA Reception Committee for event
In what mandate(s) were you EPSA Team?
*
e.g. 2016/2017
What whas your position in the EPSA Team?
*
e.g. IT Coordinator
When were you LS and for which association?
*
e.g. 2017/2018 for VFSO Belgium
When were you National IMP Coordinator and for which association?
*
e.g. 2017/2018 for VFSO Belgium
Since when are you an EPSA Trainer?
*
e.g. since 2015
For which event(s) were you Reception Committee?
*
e.g. EPSA AC 2017, Slovenia
Professional Area
*
Community Pharmacy
Hospital Pharmacy
Pharmaceutical Industry
Academia
Authority/Government
Professional Title(s) and Employer(s)
*
What you do professionally and for whom. Please also include previous posts.
Other comments
Please use this space to comment on anything you'd like related to EPSA.
I agree with the European Pharmaceutical Students' Association (EPSA) collecting the data I provided above and will store the following data: my name, surname, my email address, my country of residence, my Skype ID and my employment area in the EPSA database. I consent to receive regular email correspondence from EPSA, including alumni newsletters and other requests. I am informed that EPSA will not delete the above-mentioned data unless I request so and that I can request to delete above-mentioned data at any time.I am informed that EPSA Data Protection Officer is the EPSA Secretary General.
*
I agree
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