Candidacy Form - CCPE-CFPC

Candidacy Form for Regional Delegate

Name
First Last
CCPE PIN (optional)
Address
Street Address Address Line 2 City Province Postal Code
E-Mail Address*
Company*
Short Biographical Sketch (Maximum 900 characters)
Why I want to sit on the Board of Directors (Maximum 450 characters)
Phone
This field is for validation purposes and should be left unchanged.

Data Privacy Policy:
The Council for Continuing Pharmaceutical Education (CCPE) recognizes and respects the privacy interest of individuals with regard to personal information provided to us.

How do we use this personal information?
Personal information collected by us through the CCPE Online Registration Form will only be used to respond to your request.

How do we safeguard personal information?
The Council for Continuing Pharmaceutical Education (CCPE) uses Secure Sockets Layer (SSL) encryption when collecting or transferring sensitive data. SSL encryption is designed to make the information unreadable by anyone but us. This security measure is working when you see either the symbol of an unbroken key or closed lock (depending on your browser) on the bottom of your browser window.

Your consent
By providing personal information to us, you consent to the collection and use of the personal information in accordance with the purposes described in this privacy statement.