Closing Date: up to Four Months Before Annual POGP Conference

Closing date: up to four months before Annual POGP Conference

see web-site for details - pogp.csp.org.uk.

Please answer ALL the following questions

PERSONAL DETAILS
Name
Address
Postcode
Tel. No
Email
Qualifications
Current working position
CSP number
How long have you
been a member of POGP/ACPWH/CPPC?

1. Please attach the proposal including (where applicable) title, brief abstract, background and purpose, plan of investigation, plans for data analysis, proposed timetable and budget. In addition, please include details of supervisors or mentors supporting the project.

2. Please state the relevance of this project to Continence including the proposed benefit to both the patient and POGP (maximum 100 words).

3. Please show evidence of commitment to completing proposed research project and reasons why POGP should consider your application. How relevant is this to your career development and future CPD? (Maximum 150 words).

4. Please list relevant recent conferences/courses attended/invitations to lecture/in-service training etc.

5. Please give details and evidence of any funding:

FUNDING
Have you sought funding from any other source? If yes, please specify source and amount received.
Is your employer making any contribution? If yes, please specify amount and also any paid/ unpaid study leave.
Have you sought funding from POGP/ACPWH/CPPC before?
If yes, please specify when, amount and for what funding was received?

6. If successful, would you agree to write a review/summary for the POGP Journal if requested? Yes/ No

RESEARCH PROJECT / Amount
Registration fees
Budget (e.g. equipment, sundries, costs for time away from paid employment)
Other

7. Please itemise anticipated expenses:

Completed form, any evidence of funding and curriculum vitae (max 2 pages) should be

returned to the chairman, by email at least 4 months before the date of conference.

Email:

JLCS App form Jan 2015