Purpose

This form is to express your organisation's interest in becoming a participant in MHRA’s Patient and Community Forum. It will provide you with an opportunity to clarify:

• what value your organisation will bring to the Patient and Public Community 
• the level of contribution your organisation would be able to make and
• to improve transparency and help set your expectations of what being part of the community will entail.

This would also provide us with a ‘database’ that can be used to demonstrate the wider/extended benefits that the Patient and Public Community can offer to the MHRA (e.g. size of potential audience reach, level of authority/expertise in a given health condition/disease area).

Please read the Working Together Agreement and Data Protection Notice before you complete the form.