Pulse Speaker Form Pulse Speaker Form Step 1 of 3 33% Pulse LIVE 2024 Speaker Registration Please select the event you are speaking at (tick multiple if it applies)HiddenEvent 1 Pulse Live London - 26th March 2024 HiddenEvent 2 Pulse Live London - 27th March 2024 HiddenEvent 3 Pulse Live Leeds - 8th May 2024 Event 4 Pulse Live Birmingham - 11th June 2024 Event 8 Clinical Essentials – Cardiovascular / Diabetes / Metabolic Health - 20th June 2024 Event 5 Pulse Live Newcastle - 5th September 2024 Event 9 Clinical Essentials – Respiratory - 22nd November 2024 Event 6 Pulse Live Liverpool - 12th November 2024 Event 7 Pulse Live Glasgow - 22nd October 2024 Event Information Sorry, this event has now concluded. Date: 26th March 2024 Location: London - Novotel London West Date: 27th March 2024 Location: London - Novotel London West Date: 8th May 2024 Location: Leeds - Queens Hotel Date: 11th June 2024 Location: Birmingham - NCC Date: 20th June 2024 Location: London - Leonardo St Pauls Date: 05th September 2024 Location: Newcastle - Hilton Gateshead Date: 22nd November 2024 Location: London - Leonardo St Pauls Date: 12th November 2024 Location: Liverpool - ACC Date: 22nd October 2024 Location: Glasgow - SEC Your DetailsName(Required) Title -Please Select-DrMissMrMrsMsProf Forename Surname Email(Required) Enter Email Confirm Email Which job title most closely matches your job role:(Required)-Please Select-GP PartnerGP PharmacistGP Registrar/ TraineeGPwSIPortfolio GPSalaried GPSessional/ Locum GPOther, Please SpecifyOther Job Role(Required) HiddenYear of Study GPST1 GPST2 GPST3 Work Phone NumberMobile Phone Number(Required)Work AddressPractice Name/ Place of Work:(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country HiddenHow did you hear about us?-Please Select-Pulse MagazinePulse E-NewsletterOur EventsGoogle AdvertOther Online AdvertEmailWeb SearchNewspaper StoryTwitterFacebookLinkedInFaxDirect MailFriend/ ColleagueTelemarketing GDPR/DATA PROTECTIONBy allowing my badge to be scanned by a sponsor company in the exhibition hall or at sponsored sessions, I am agreeing for the event organisers to pass on my details provided to this company and for this third party to contact me after the event about their products, events and/or services - some of which may be promotional in nature. I have the right to contact them to have my data removed or to not have my badge scanned. The personal data provided in this form will be processed in accordance with UK law by Cogora Group Ltd. In addition to the purposes described above, we may process your information for carefully considered and specific purposes to enhance the services we provide. You have the right to object to this processing if you wish. For further details on how Cogora Ltd may process your information and your rights in relation to the information we hold on you, please visit our privacy policy or telephone us on 020 7214 0500. Please note that your name, phone number and email address may be passed onto third parties including, but not limited to, the venue, public health authorities and NHS, for the purposes of contact tracing purposes.Cogora Limited Registered in England No. 02147432 Registered Address: 1 Giltspur St, London EC1A 9DDSpeaker DeclarationBy signing, I agree that I am aware that there may be journalists present at the event from Cogora, the organiser of the events, and external media and that details of my seminar/workshop may be reported. Cogora may also record the session and share my presentation with delegates and other relevant members of the healthcare community. I consent for video footage of me/my session to be shared with delegates and relevant healthcare professionals online by Cogora.(Required) Yes No I consent for photographs of me/my session to be used for marketing and PR purposes by Cogora.(Required) Yes No I consent for my presentation to be shared with delegates and relevant healthcare professionals after the event.(Required) Yes No Sign (type your name)(Required) HiddenAdmin- Please enter the Event/Issue ID's into the relevant box. - Please enter the marketing reference.HiddenMarketing Reference