PMDA-ATC Seminar 2025 Application form

*Full name

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.
ex) Taro PMDA [first, then family name]
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

*Country

*Organization

*Organization (other)

If you selected "Other" in the preceding section, kindly provide the name of the organization with which you are affiliated.

*Location of your office

Headquarters

Local office

*Department / Division

*Attendee e-mail address

This will be used for all communications from the Secretariat. Please ensure that it remains accessible while you are traveling overseas and in urgent situations.

*Attendee e-mail address (sub)

Please enter an alternative e-mail address for back up purpose.

Any other e-mail address (If necessary)

Additional e-mail addresses to which copies of communication with the Secretariat should be sent.
(e.g. your supervisor or admin support staff)

*Phone number (Office)

*Phone number (Mobile)

Phone number (Mobile in Japan)

Phone number available during the stay in Japan

*Name and title of Head of Organization 1) Name:

All seminar invitees will receive an official letter addressed to their affiliated organization’s Head.
For this purpose, type the full addressee name with title, (e.g. Dr FUJIWARA Yasuhiro).

*Name and title of Head of Organization 2) Title:

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

*Your expertise field

*Level of your expertise field

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

*Experience on GMP inspection

How many times have you ever conducted on-site GMP inspections?

less than 5

5 to 10

11 to 20

more than 20

*Your current regulatory appointments

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

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

1. Please download the format from the following link; Signature form
2. Please print out the form and have both your signature and the signature of the head of organization on it.

3. Please upload the PDF file
→ link to Signature instruction

*Travel arrangement by PMDA

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

Do you have a valid passport?

Yes

No

*Surname

Please enter Surname (Family name) written in your passport

*Given name

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

*Visa application (1)

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
-----------------------------------------------------------------------------------
Do you need PMDA assistance to provide Visa application documents?

Yes

No

*Visa application (2)

If No, please check your answer.

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

I will be using official/diplomatic passport.

I already have a multiple-entry Japan Visa.

of other reason

*of other reason comment

*Health condition

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

Yes

No

If it is No, please enter a comment.

*Announcement from PMDA

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.