2023 NEW ISPE MEMBER APPLICATION
CONTACT INFORMATION (PLEASE TYPE OR PRINT CLEARLY)
Prefix
First Name
*
MI
Last Name
*
Job Title
*
Company
*
Primary Mailing Address
Home
Work
Address
*
Apt./Suite/Mail Stop
City
State/Province
Country
*
ZIP/Postal Code
Email Address
*
example@example.com
Business Phone
Mobile Phone
Please text me with updates and special offers (standard data rates may apply)
BACKGROUND INFORMATION (OPTIONAL)
Gender
Male
Female
Non-binary/third gender
Prefer not to say
Prefer to self-describe
Date of Birth
-
Month
-
Day
Year
Date
Approximate number of years you’ve been working in the pharma industry
MEMBERSHIP CATEGORIES (SELECT ONE)
I want to go GREEN! I want the digital-only subscription to Pharmaceutical Engineering® magazine.
EMERGING ECONOMY MEMBERSHIP *Application proof required.
*
Industry: 6,600 THB / Year
Acedamic: 4,300 THB / Year
Emerging Leaders (EL): 2,200 THB / Year*
Student: 360 THB / Year*
Government - Industry: 0 THB
Government - Emerging Leaders: 0 THB*
If applying as "Student", please indicate YEAR that you are or will be graduated?
*
If applying as "Emerging Leaders (EL)" , please indicate YEAR that you are or will be graduated?
For "Emerging Leaders (EL)", please attach Graduation Certificate as evident, or you can scan and send to ISPE Thailand later
Browse Files
Cancel
of
Attach Student ID Card as evident, or you can scan and send to ISPE Thailand later
Applicant’s Signature
*
Date
/
Month
/
Day
Year
Date
PRIMARY JOB FUNCTION/ ROLE (Select only 1)
*
Architect, Engineer, Construction
Clinical Materials, Investigational Products
Procurement, Buyer, Planners
Health, Safety, Environmental
Knowledge Management
Operations, Plant Mechanics (electric, utilities, HVAC), Facilities, MaintenancePlanning
Process Control, Automation
Project Management
QA, QC, Regulatory Compliance
Research and Development, Technology Transfer, ProcessDevelopment
Sales, Marketing
Statistician
Technical Services, Product Support, Information Systems
Validation, Qualification, Commissioning
Supply Chain Management,Warehouse Operations, Logistics Planning
Retired
Student
Unemployed
Other
LEVEL OF RESPONSIBILITY (Select only 1)
CEO, President, Owner, General Manager
Vice President, Chief Officer
Director, Division Manager, Senior Manager
Manager, Section Head, Supervisor
Team Lead, Operator, Technician, Staff
Dean, Professor, Educator
Student, Post-Doctoral Fellow
Retired
Other
PRIMARY COMPANY TYPE (Select only 1)
API, Excipient Supplier, Distributor
Contract Manufacturer
Cosmetics, Nutraceuticals, Food Manufacturer
CROs, Clinical Materials, InvestigationalProducts
Educational or Government Entity, Libraries
Engineering, Architecture, Construction
Equipment, Material Supplier
Generics Manufacturer
Laboratory Services
Medical Devices, Diagnostic Manufacturer
Pharmaceutical, Biotech Manufacturer (NotCMO)
Service Provider, Consulting
Veterinary Medicine
Other
PROFESSIONAL COMMUNITIES OF INTEREST (select all that apply)
Active Pharmaceutical Ingredients
Biotechnology
Commissioning and Qualification
Containment
Critical Utilities
Disposables
Emerging Leaders
GAMP
GAMP Blackchain Special Interest Group
GAMP Data Integrity Special Interest Group
GAMP MES Special Interest Group
Investigational Products
Oral Solid Dosage
Pharma4.0 Special Interest Group
Process Analytical Technology & Lifecycle Control Strategy
Project Management
Sterile Products Processing
Supply Chain, Operation and Packaging Excellence (SCOPE)
Sustainable Facilities, HVAC and Controlled Environments
Regulatory and Quality Networking
Virology Special Interest Group
Women in Pharma
LOCAL AFFILIATES AND CHAPTERS
Thailand
Other
DATA SHARING
ISPE occasionally shares mailing addresses (not email) with like-minded companies, including exhibitors at conferences. If you prefer to not receive their information, please check this box.
Other Members may search the Member Directory and Conference Attendee lists to make connections. If you prefer to not have your contact information made available, please check this box.
I wish to keep my data confidential and it is given only for use by ISPE and its Chapters and Affiliates. (This excludes you from the conference attendee listing, Member Directory, and Exhibitor List.)
Save
Submit
Should be Empty: