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Pharmaceutical Medicine

Pharmaceutical Medicine Part time module and fee form 2019-20

  • Name
  • Registration / membership numbers
    Please provide the appropriate registration / membership numbers. Multuple selections are permitted.
  • Funding declaration
  • Sponsor details
    If you have selected sponsored at the funding declaration, complete their details below
  • Invoice contact name
  • Company address
  • Choose your modules
    Please note that priority places will be given to full-time students. Remaining places will be offered on a first come, first served basis to part-time award and non award students upon receipt and successful processing of application. Please review the course dates page for details on when courses are offered.
  • Module selection
  • Next steps
    Once submitted your request will be checked against availability for your chosen modules and you will be responded to with the outcome of your application by email within three working days.
  • I agree that I have completed this form after reading the information available on Fees and Funding, Course dates and Course Core and Optional Module Table.
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