AAPS EXPERT RESOURCE DATABASE PARTICIPATION SURVEY

Note: This information will be used by AAPS Newsmagazine and Information Staff only, and will not be distributed to the public. An asterisk(*) indicates that the field is required.

1. Personal Information:

* Name
* Company
Department
Title
* Address
* City
State
Zip Code
* Country
* Phone
Fax
* E-Mail
Beeper Number
Home Number (optional)
Cell Phone Number

* Please check your area of expertise:
Drug Discovery Drug Development

* Please choose one of the following that best describes your area of expertise:
Analysis and Pharmaceutical Quality
Biotechnology
Clinical Sciences
Economic, Marketing and Management Sciences
Medicinal and Natural Products Chemistry
Pharmaceutical Technologies
Pharmaceutics and Drug Delivery
Pharmacokinetics, Pharmacodynamics and Drug Metabolism
Regulatory Affairs

* Please list your specific area(s) of expertise (up to 5):

* 2. Can you recommend a colleague for inclusion in the database?

Yes No

If yes, please list name and address:

* 3. The single best way to reach me is:

Work phone
Cell Phone
Beeper
Home Phone
Fax
Email

* 4. Have you ever received any media training?

Yes No

If yes, please describe:

If no, would you be interested in receiving media training from AAPS?

Yes No

* 5. Do you have any experience in dealing with the media?

Yes No

If yes, please describe:

Please paste your Biography below:

American Association of Pharmaceutical Scientists
2107 Wilson Blvd, Suite 700, Arlington, VA 22201-3046
Main Telephone: 703 243 2800 Main Fax: 703 243 9650
Email: aaps@aaps.org
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