Fields that you must complete are marked with this symbol:
Please provide full name; not initials, abbreviations etc.
Family name as shown on passport or birth certificate.
Mandatory. Please include the relevant dialling codes(s). This is the number we would normally use to contact you.
Optional. Please include the relevant dialling codes(s). This is the number we would normally use to contact you.
This is the email address which you intend to utilise for correspondence with the MHRA.
Please retype your email address. This is required to make sure the email address provided is correct as this will be the principle means for communication.
Passwords must be at least 8 characters long and must contain: 1) At least one single Upper case alphabetical character 2) At least one single lower case alphabetical character 3) At least one single numerical character 4) At least one single special character eg *&#!@%