ATOPP Live PIE Session Registration Form

This is a registration form for the Live Pre-Approval Information Exchange (PIE) Sessions at ATOPP taking place in Salt Lake City, UT at 10:30am and 1:30pm.

Name:*

First NameLast Name

Job Title:*

Company Name:*

Contact Email:*

example@example.com

YesNo

Member of a formulary committee (e.g, P&T committee)Individual who provides information to a committee that selects drugs to include on formulary or within treatment pathways (eg, P&T committee)Member of a committee that makes decisions regarding drug selection, formulary inclusion, coverage, reimbursement, clinical pathways, healthcare quality, patient outcomes, or contracting for health care organizations (e.g., integrated delivery networks, hospitals, health systems, GPOsAn individual who provides information to a committee that makes decisions regarding drug selection, formulary inclusion, coverage, reimbursement, clinical pathways, healthcare quality, patient outcomes, or contracting for health care organizations (e.g., integrated delivery networks, hospitals, health systems, GPOs).Formulary decision maker for a payer by providing information for the purpose of making formulary decisionsI do not qualify as a HCDM based off the roles listed. See Non-HCDMs Pre-Registration Limitations Information at the end of the document

I attest that I meet the HCDM criteria.I do NOT meet the HCDM criteria - See Non-HCDMs Pre-Registration Limitations Information at the end of the document.

Session 1 at 10:30-11:15am - Syndax presenting RevumenibSession 2 at 10:30-11:15am - AstraZeneca and Daiichi-Sankyo presenting Fam-trastuzumab deruxtecan-nxki (T-DXd): DESTINY-Breast09Session 3 at 1:30-2:15pm - Amneal presenting Unlocking Value in Oncology Care: Delivering Access Through Amneal’s upcoming Biosimilar and 505(b)(2) launchesSession 4 at 1:30-2:15pm - Sobi presenting avatrombopag (Doptelet) with the indication of pediatric ITP

Please rank the order of which PIE Session(s) on July 11 you would like to attend. We will do our best to accommodate these preferences.*

Once you have been approved as a health care decision maker (HCDM) by the pharmaceutical company, we will reach out with the PIE Session(s) you are registered for at ATOPP 2025. Thank you for your interest and we look forward to having you participate!

Non-HCDMs Pre-Registration Limitations

You indicated you do not qualify as a Health Care Decision Maker (HCDM) based on the criteria provided. Please note that you cannot register for a PIE Session at this time. Please reach out via email if you have any questions or believe you qualify to attend a PIE session at events@atoppsummit.com.

Signature*

Date*

Date