ATC Change Request Form

If you would like to request a change to the ATC then please use this form. EphMRA will get back to you as convenient. Please highlight and delete the words in the form below before you type your own - they are just to show what should be typed there.


Name*
Company*
Department*
Company Address*
Country*
Telephone Number*
Email Address*
Date of Request*

Are you the requestor located at the company’s worldwide corporate headquarters?*
If answer is ‘no’ (i.e. not at HQ), then please provide contact information of corporate headquarters person who has approved this request:

(2) Name
(2) Email Address
(2) Department/Job Title

Please provide a brief overview of the reasons for the change request:*

Please provide your proposed new class structure and include class names, class descriptions, products and/or types of products to be included in new and affected classes:*
Please list current classes that may be affected by proposed change:*
Please send through any background information. Email to both Theresa Ormiston - Tormiston@uk.imshealth.com and Alice Burstein - alice.burstein@pfizer.com

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ATC Change Request Form

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