| *Surname | Please enter your official surname (family name).
ex) The surname written in your passport.
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| *Given name | Please enter your official given name (first name).
ex) The given name written in your passport.
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| Full name for the certificate | Only in case if you have a long name more than 30 letters OR you request us to use your name other than above (first name, last name), please enter your name within 30 letters including space.
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Calling name
(Short name) | Please let us know your calling name or short name by which you prefer to be called casually during the webinar, especially in the group discussion.
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| Male / Female | |
| *Job title | |
| *Country | Please choose your country.
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| *Organization | Please choose your organization.
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| *Organization(other) | If you chose "Other" in the above, please describe here.
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| *Department / Division | |
| *Attendee e-mail address | Please enter e-mail address that can be used for communications with the secretariat and contacted in an urgent situation.
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| *Attendee e-mail address (sub) | Please enter an alternative e-mail address for back up purpose.
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Any other e-mail address
(If necessary) | Other e-mail address you need to include in the communiations with the secreariat.
(supervisor,secretariat, etc...)
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*Phone number
(Office) | |
*Phone number
(Mobile) | |
*Name and title of your supervisor
1) Name: | (e.g. “Dr. FUJIWARA Yasuhiro”: Make sure to include Mr. Ms. or Dr.)
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*Name and title of your supervisor
2) Title: | When you are chosen as the participant, an acceptance letter addressed to you and your supervisor will be provided.
(e.g. “Chief Executive of PMDA”)
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| *Your expertise field | |
| *Other expertise field | If you chose "Other" in the above, please describe the details of your field.
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| *Level of your expertise field | |
| *Years of experience | Please fill in years of experience in cell therapy and gene therapy products review.
years |
| *Your expectation | What specific issue you want to address in your work and what aspect you expect to learn from the seminar. Briefly describe with a 300 character limit. (around 80 words)
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| *Declaration of application | 1. Please download the format from the following link; Signature form
2. Please print out the form and put you and your supervisor's signature on it.
3. Please upload the PDF file
→ link to Signature instruction |
| *Announcements from PMDA | PMDA would like to send announcements regarding PMDA international activities (e.g., PMDA-ATC seminars, PMDA Updates) to your email address.
If you do NOT wish to receive these emails, please check the following box.
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PMDA would like you to submit the “Commitment Form” from the below to gain access to the webinar materials and attend the live sessions. Please read through each paragraph, enter necessary information and click "Agree"
Commitment Form
To: Chief Executive of the Pharmaceuticals and Medical Devices Agency
I hereby pledge that during the course of the webinar program (“Program”), I agree:
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| Clause 1 | TO NOT copy, capture, photograph, record or use any other means of visual or audio duplication, any part of the material provided during the course of the program for any purpose, such as secondary use of the information therein.
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| Clause 2 | To concentrate on the training activities and make best efforts to achieve the objectives of the Program.
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| Clause 3 | To comply with instructions by PMDA on confidentiality of information, and not reveal, plagiarize, abuse any person’s privacy nor any intellectual property or confidential information which I may know during the course of the Program and to comply with the instructions on confidentiality after the webinar.
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| Clause 4 | To prepare myself for the live sessions of the Program;
- Learn specific contents of the E-learning course or other learning materials, that may be specified, to gain general knowledge about the subject,
- Submit all deliverables as instructed in each session before due as specified individually,
- Fulfil any other obligations as may be required for the preparation.
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| Clause 5 | To participate actively in the live sessions of the Program;
- Place myself in the least distractive environment during the sessions not to disturb other participants,
- Refrain from engaging in any work other than the Program,
- Cooperate with other members of the group which I am assigned, if a group work is scheduled in the Program, and make best efforts to maximize the performance of such a group.
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| Clause 6 |
To provide feedback of my experience in the webinar to PMDA for future improvement.
- Submit the filled-out Evaluation Form of the sessions completed during the day and also the Evaluation Form for the overall seminar before due as specified individually.
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| Clause 7 | |
| Clause 8 | |