Application form for
APEC CoE Workshop: PMDA-ATC Pharmacovigilance Seminar 2027

Full name Required

The information you provide here will be used exactly as entered, including upper and lower case letters, for official documents such as certificates and the participants list. Please ensure accuracy.
If your full name exceeds 30 letters including spaces, please shorten to fit within the 30 letters limit.

Male / Female

Male

Female

Calling name (Short name)

Name you wish to be called during the seminar, especially during discussions.

Job title Required

Country Required

Country_other Required

Organization Required

Organization (Other) Required

Department / Division Required

Where are you based? Required

Headquarters

Local office

Which local office? Required

Applicant e-mail address (main) Required

This will be used for all communications from the Secretariat. Please ensure that it remains accessible while you are traveling overseas, and throughout the holiday seasons, and in urgencies.

Applicant e-mail address (sub) Required

Please enter a different e-mail address for back up purpose.

Phone number (Office) Required

Head of Organization 1) Name: Required

All seminar invitees will receive an official letter addressed to their affiliated organization’s Head.
For this purpose, type the full addressee name with honorifics,

Head of Organization 2) Title: Required

All seminar invitees will receive an official letter. Please type the title of your affiliated organizations’s Head here.

Your expertise field

Your expertise field (other)

Level of your expertise field Required

Beginner

Intermediate

Advanced

Years of experience as a regulator in the field

Please fill in years of experience as a regulator in the field.
years

Your current regulatory appointments Required

Describe your current regulatory appointment in as much detail as possible, within a 300 character limit (including letters, numbers, spaces and punctuation, not 300 words).

Your expectations Required

What specific issue you want to address in your work and what aspect you expect to learn from the seminar.
Briefly describe within a 300 character limit. (including letters, numbers, spaces and punctuation, not 300 words)

Declaration of application Required

Important Notes Regarding the Application Confirmation Form

1. Download the application confirmation form using the following link: Application Confirmation Form

2. Print the application form and obtain all required signatures. Please refer to the following guidance: guidance

Please note that applications will only be considered if they include all required signatures, including that of the Head of the regulatory authority of your country/region (e.g., CEO, Director General, etc.).

3. Click the button below to upload a scanned copy of the signed application confirmation form in PDF format.

Travel arrangement by PMDA Required

PMDA may provide flight tickets and accommodation as long as the participant follows an itinerary arranged by PMDA. Do you accept PMDA arrangement?

Yes.

I don’t need PMDA arrangements. I or my organization will bear them.

Passport Required

Do you have a valid passport?
Selected participants will be asked to submit a copy of their valid passports within a week of the invitation.

Yes

Surname Required

Please enter Surname (Family name) written in your passport.

Given name Required

Please enter Given name (First name) written in your passport.

Visa application (1) Required

Please check documents required for traveling to Japan:
⋅ Confirm details at:
https://www.mofa.go.jp/j_info/visit/visa/short/novisa.html

⋅ For official/diplomatic passport holders:
https://www.mofa.go.jp/ca/fna/page22e_000692.html
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Do you need PMDA assistance to provide Visa application documents?

Yes

Visa application (2) Required

If No, please check your answer.

my country/region is not required Visa to enter Japan.

I already have a multiple-entry Japan Visa.

will be using official/diplomatic passport.

of other reason

Health condition Required

Can you participate in the seminar without any specific medical assistance during your stay in Japan?

Yes

If it is No, please enter a comment.

Announcements from PMDA Required

PMDA would like to send announcements regarding PMDA international activities (e.g., PMDA-ATC seminars, PMDA Updates) to your email address.

Do you wish to receive announcements from PMDA?

Yes.

No, I do not wish to receive these announcements.

Online participation Required

Online participation will be available for select lectures to qualified applicants not selected for in person participation.

If you are not selected for in person participation, would you be interested to participate online?

Yes

Asia Training Center for Pharmaceuticals and Medical Devices Regulatory Affairs (PMDA-ATC)