Personal Information

ELEVATE: Advancing Bowel Care Together - Liverpool

19 November 2026

09:15-15:45

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Personal Information

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* First name

* Last name

* Work email address

* Mobile number

Please enter your mobile number starting with your country code (e.g. +44)

* Hospital name/organisation - Please specify full name of workplace (no abbreviations)

Please provide Hospital/organisation's postcode e.g. PE26FX (should be up to 7 characters comprising of letters and numbers with no space)

Enter text between 5 and 8 characters long.

Occupation

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Medical Speciality

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if other selected, please specify

* Job title

* Name of your Coloplast representative

Do you have any dietary requirements?

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Please select from list below:

Gluten free
Lactose
Vegan
Vegetarian
Other

Do you have any accessible requirements?

Consent for data processing

By providing your personal data, you are consenting to Coloplast Limited (“We”) to process and store your data for the purposes of this event and to keep you informed about it via phone, text, email, or post. We may share your data with Coloplast A/S and its group companies and our sub-vendors when necessary to support our event and transfer data securely outside the EU to support our business operations.

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Marketing permission

From time to time, We would like to contact you about relevant Coloplast products and services or forthcoming events. Our communication to you will be based on the information you provide to us and your preferences and interests. Please indicate your preference below. The choice is yours – and as with any of our services, you may opt-out at any time.

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