P.M.C.Q. Membership Application Form Simply complete and return this form or bring this completed form with you to our next meeting.All fields marked with a * are required Name *: Title: Company * : Address * : City *: Postal Code *: Province *: Telephone *: Fax: Email *: If you would prefer to receive meeting notices at a different address, please indicate address below: Address: City: Postal Code: Province: Occasionally the PMCQ mailing list is made available to organizations for subjects of interest to our members. If you do not wish to receive such information, check here. Please indicate your industry classification: Pharma CompanyBioTechAdvertising AgencyMediaCHE / CMEOther If Other: What are your suggestions for educational content for future meetings?