9 November 2017 EMA/743635/2017 Human Medicines Development and Evaluation

Workshop on site and histology – Independent indications in oncology Registration form Please return by e-mail

Date: Place:

14-15 December 2017 EMA, London, UK

Participation in person: Participation via Adobe Connect: Participant information: Family name:

_________________________________________________

First name:

_______________________________________________________

Organisation:

_______________________________________________________

Address:

_______________________________________________________

Postal code:

________________________ City:__________________________

Country:

_______________________________________________________

Telephone:

_______________________________________________________

E-mail:

_______________________________________________________

Deadlines: Registration should be submitted electronically no later than 01 December 2017 to the following email address: [email protected]

30 Churchill Place ● Canary Wharf ● London E14 5EU ● United Kingdom Telephone +44 (0)20 3660 6000 Facsimile +44 (0)20 3660 5555 Send a question via our website www.ema.europa.eu/contact

An agency of the European Union

© European Medicines Agency, 2017. Reproduction is authorised provided the source is acknowledged.