Register – Merz Therapeutics Education Hub

Title *

First Name *

Surname *

Role *

Role Other *

Trust/Hospital Name *

GMC/GPHC/NMC/HCPC professional number *

Where did you hear about us? *

Which areas are you interested in? *

Dystonia

Saliva Control

Spasticity

Are you currently an injector of Botulinum Toxin? *

Yes
No

This form is required for Merz to register you as a user of the Educational Hub. The personal data we collect as part of this is required for validation and registration of you as a user of the platform. We may use your details to contact you about relevant training material. Merz do not share this data with any third parties, and it is stored securely within the platform itself.

Email

In addition, I consent to Merz contacting me directly with detail on appropriate;

Events

Promotional Material

For more information about how Merz handles personal information, please see the Merz Pharma UK Ltd privacy policy statement at

Password

Confirm Password

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Hint: The password should be at least twelve characters long. To make it stronger, use upper and lower case letters, numbers, and symbols like ! " ? $ % ^ & ).