• Attendee Information

• Business Email

• First Name

• Last Name

• Job Title

• Company

• Address (no P.O. boxes)

• City

• Postal Code

• Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Canada Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d’Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

• Work Phone [Without spaces, starting with 00 and country code. (Ex.: 0034, 0033)]

• Mobile Phone (Mobile will only be used if necessary for important Summit related SMS messages) [Without spaces, starting with 00 and country code. (Ex.: 0034, 0033)]

• Job Level C-Suite VP Director Manager Staff

• Is your role primarily Business or IT focused? Business IT

• Emergency Contact Full Name

• Emergency Contact Phone Number (without spaces, starting with 00 and country code. Ex.: 0034, 0033)

• Event Preferences

• Have you attended a Veeva Summit before (in person or online)? Yes No

• Please identify your primary area of interest Clinical Data Patient Solutions Clinical Operations Quality and Manufacturing Regulatory Safety Vault Platform

• Please identify your secondary area of interest Clinical Data Patient Solutions Clinical Operations Quality and Manufacturing Regulatory Safety Vault Platform

• Do you plan to attend the Welcome Reception? (03 Jun, 6:30 p.m. - 8:00 p.m. CEST) Yes No

• Do you plan to attend the Evening Event? (04 Jun, 7:00 p.m. - 10:30 p.m. CEST) Yes No

• Accommodations & Dietary Restrictions

• Do you plan to book a room at the conference hotel with the Veeva preferred rate? (All attendees are required to book their own accommodations. We will send you the booking link by email as soon as your registration has been approved) Yes, I will book my hotel accommodations with the Veeva preferred rate. No, I will book at another hotel No, I do not need a hotel

• Please provide details on any dietary restrictions

• Quick Survey

• How did you hear about Veeva R&D and Quality Summit, Europe? Veeva Email Veeva Website Veeva Connect Veeva Social Media Pages Veeva Representative Veeva Webinar Veeva Speaker Veeva Partner Google Search Magazine/Publication (please specify) Association (please specify) Other (please specify)

• Please specify

• Communications

• Please opt-in to receive your confirmation email from Veeva. You can unsubscribe at any time. I want to receive Summit related notifications from Veeva and other marketing information: similar events, webinars, or other product news.

• Please be aware that when you scan your badge at a Veeva partner booth, at Summit, your contact information will be shared with that partner.

• Please be aware that Veeva may take photographs and video material in public areas of this Summit and we may use these materials in marketing materials on our website and social media channels to enhance awareness of our events. You can directly request us to not use your individual photographs or videos for this purpose by writing to us at vse.team@veeva.com. For more information please visit https://www.veeva.com/eu/privacy/

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