Ivf Award2016 Application Form

IVF AWARD2016| APPLICATION FORM

Company Name:
Company Address:
City: / Postal Code: / Country:
E-mail: / Phone:
TAX ID No.:
Owner or Manager (name, position):
Phone: / E-mail:

IVF AWARD CATEGORY/CATEGORIES:
Please, check[] one or more categories you wish to apply for.

Innovations
Customer Service & Communications
Personalized Treatment
Intimacy & Care / The IVF Program
The IVF Egg Donation Program
The IVF PGS/PGD Program / IVF Agency of the Year 2016
Sperm Bank of the Year 2016
Egg Bank of the Year 2016

PRELIMINARY APPLICATION
(Please complete where applicable.)

Year of establishment:
No. of IVF cycles (own eggs):2014: 2015:
No. of IVF egg donation cycles:2014: 2015:
No. of physicians: No. of medical staff (midwives/nurses):
No. of embryologists: No. of customer service staff:
Member of organizations: [please specify; comma separated list]
Certificates and awards [please specify, comma separated list]
Percentage of IVF programs for foreign patients:

IVF CLINIC OF THE YEAR 2016
CATEGORIES APPLICATION
Please describe the category/categories you wish to apply for

INNOVATIONS
Explain and justify the way your clinic stands out in the field of innovation. Describe what revelatory solutions, projects, products or methods your company has introduced in the past 5 years. (max. 2500 characters):

CUSTOMER SERVICE & COMMUNICATIONS
Explain and justify the way your companydistinguishes itself in the field of customer service and communications. Describe in what way your clinic cares for patients’ comfort and communicates with infertile couples; what improvements you have made concerning this topics. (max. 2500 characters):

PERSONALIZED TREATMENT
Explain and justify the way your company stands out in the field of personalized treatment. Describe how your clinic adjusts the treatment process to patients’ needs, expectations and their individual situation. (max. 2500 characters):

INTIMACY & CARE
Explain and justify the way your companydistinguishes itself in the field of intimacy and care. Describe solutions you have introduced to ensure that patients feel safe, can share the sense of privacy and receive support at every stage of treatment. (max. 2500 characters):

IVF PROGRAM
Write up elements which distinguish your IVF Program from other offers. Describe its characteristics designed to fulfill patients’ expectations and to maximize chances for pregnancy. (max. 2500 characters):

EGG DONATION PROGRAM
Write up elements which distinguish your Egg Donation Program from other offers. Describe its characteristics designed to fulfill patients’ expectations and maximize chances for pregnancy. (max. 2500 characters):

IVF PGS/PGD PROGRAM
Write up elements which distinguish your IVF PGS/PGD Program from other offers. Describe its characteristics designed to fulfill patients’ expectations and maximize chances for pregnancy(max. 2500 characters):

IVF AGENCY OF THE YEAR
Write up elements which distinguish your Agency from others. Describe what kind of solutions you have introduced to fulfill patients’ expectations and needs in terms of organization, communication, lawfulness,etc.(max. 2500 characters)

SPERM BANK OF THE YEAR
Write up elements which distinguish your Sperm from other offers. Describe what kind of solutions you have introduced to fulfill patients’ expectations and needs in terms of organization, communication, lawfulness, etc.(max. 2500 characters)

EGG/OOCYTE BANK OF THE YEAR
Write up elements which distinguish your Egg/Oocyte Bank from other offers. Describe what kind of solutions you have introduced to fulfill patients’ expectations and needs in terms of organization, communication, lawfulness, etc.(max. 2500 characters)

*Please note:

Submitting the IVF AWARD 2016 Application Form is tantamount to placing an order.

The results shall be announce on March1st, 2017.

I declare that I have read the rules and I accept as legally binding: IVF CLINIC AWARD Terms & Conditions, Version [2.0]. Last Updated: September2016 and Terms and rules of advertising services provided by the IVF Media.

Place, date / Company’s stamp / Signature of person authorized
to company’s representation

1. How to enter

1.1. To enter the IVF AWARD all applicants must read and understand the Terms and Conditions and complete the Entry Form for your chosen category.

1.2. Applicants must be authorised to enter their organisation into the AWARDs programme.

1.3. Participation in the IVF AWARD is by the official entry forms only available at

1.4. By lodging your submission, you agree to be bound by the Terms and Conditions of entry.

1.5. Entries must be in English.

2. Who can enter

2.1. Entries can be made by any: IVF Centre, IVF Medical Agency, Sperm Bank, Egg Bank.

2.2. All businesses must have been in operation for at least two years.

3. Entry requirements

3.1. All entries for consideration must be lodged via e-mail: and include the required information. Word's forms will be accepted only.

3.2. IVF Media reserves the right to declare any entry ineligible, if during the term of the AWARD process your entry form is incomplete or deficient, false or misleading in any way.

3.3. Your entry will be allocated to the IVF AWARD category, based on your entry form.

3.4. You must be a web-enabled at least at one of the IVF Media website.

3.5. It is the responsibility of the applicant to provide the relevant information for their entry.

3.6. Entries for more than one AWARD may be submitted, but separate entry forms and supporting statements and back ground materials are required. We strongly advise companies that each AWARD entry form is completely individual, we do not encourage cut and pasting across AWARD categories.

4. Dates

4.1. IVF Media reserves the right to extend or vary the entry period if required, before or after the AWARD entry period commences.

4.2. Deadline for receipt of entries is December 31st, 2016.

4.3. The results announcement will take place on March 1st, 2017.

5. Judging Panel

5.1. All entries are judged by the IVF AWARD Jury, composed of the IVF Media Founders.

5.2. The jury decision is final and no further correspondence will be entered into.

5.3 In situations where there is only one entrant for a category, this entry will be judged.

5.4. The organisers reserve the right to audit any or all information supplied by an entrant and each entrant agrees to assist the organisers in any such audit in every way possible.

5.5. For any applicant knowingly providing false information on their application, the organisers reserve the right to withdraw any AWARD to that organisation, to publicise the withdrawal, and present the AWARD to another applicant.

5.6. The judges reserve the right to alter AWARD categories in the light of entries received. They reserve the right to cancel an AWARDs category.

6. AWARDs

6.1. The IVF AWARD comprise of the following categories:

•IVF Clinic of the Year 2016 - Innovations

•IVF Clinic of the Year 2016 - Customer Service & Communications

•IVF Clinic of the Year 2016 - Personalized Treatment

•IVF Clinic of the Year 2016 - Intimacy & Care

•IVF Clinic of the Year 2016 - The IVF Program

•IVF Clinic of the Year 2016 - The Egg Donor Program

•IVF Clinic of the Year 2016 - The IVF PGD Program

•IVF Agency of the Year 2016

•Sperm Bank of the Year 2016

•Egg Bank of the Year 2016

6.2. Winners will be notified by phone or email, and published on the IVF Media websites.

6.3. Entry does not grant an organisation rights to use the AWARDs' name, logo or images without the express written approval of the IVF Media.

6.4. The decision of the judges is final and no correspondence on their decision will be entered into. AWARD winners may state in advertising/promotional activity and on their stationery that they are a winner but this must include the category and the year in which the AWARD was won.

7. Confidentiality

7.1. All information provided in the entry form will be used for the purpose of judging only and will be treated as commercial-in-confidence by IVF Media.

7.2. If you are the winner, the information provided in the entry will be used for the purpose of promoting the AWARDs and your business.

7.3. Winning entries may be publicised at IVF Media websites. Applicants are responsible for making appropriate arrangements to protect any intellectual property associated with their application.

Contact Person: Conrad Szatkowsky, Phone: +44 020 3286 8744, E-mail: