Educational Grant European Pressure Ulcer Advisory Panel Rome 2018

Educational Grant European Pressure Ulcer Advisory Panel Rome 2018

Industry Application Form

Educational Grant – European Pressure Ulcer Advisory Panel Rome 2018

Instructions – Please read before completing the form
  • Grant applications must be submitted at least 60 days prior to the event/activity taking place with all supporting documentation attached. Any application not complying with this timeline will be rejected.
  • Please note there is no guarantee that all of the amount requested will be granted. The application maybe rejected, approved in full or approved at a lower amount.
  • One form must be completed for each applicant.
  • The form has been pre-populated as much as possible with EPUAP 2018 Conference information. The areas requiring completion are highlighted in pink.
  • The completed and signed form must be submitted by e-mail directly to a Medtech company.

1. Healthcare Organisation Details
Organisations full name
Address
Department
Website
2. Key contact details
Manager submitting the application / Full name:
Position:
Email:
Applicant (potential recipient) / Full name:
Position:
Email:
3. Grant Request Details
Type of Grant / Support for HCPs attendance at Third Party Organised Educational Event: EPUAP Annual meeting/conference, Rome, 12-14 Sept, 2018.
Therapeutic or diagnostic areas / Pressure Ulcers
Please provide a detailed description on how the grant will be used.
Note:
Generally, the grant must only cover the costs related to the costs of registration, travel and accommodation of participating HCPs. The grant will not be provided to cover the costs linked to the organisation of leisure/entertainment activities or for the invitation of spouses/partners of HCPs. In addition, no funding will be provided to cover ordinary operating and/or running costs of the organisation and other budget items not directly linked to the education. / Registration
EPUAP 2018 conference registration
Early member fee € 325 ☐
Early non - member fee € 460 ☐
Late member fee € 455 ☐
Late non-member fee € 582 ☐
Early registration deadline is 4th June 2018.
Travel (tick as applicable and indicate amount)
Flights ☐ indicate amount: €______
Trains ☐ indicate amount: €______
Mileage ☐ indicate amount: €______
Taxi ☐ indicate amount: €______
Total Travel Amount requested: €______
Accommodation (tick as applicable and indicate amount)
Number of nights:
1 ☐ indicate amount: €______
2 ☐ indicate amount: €______
3 ☐ indicate amount: €______
Other ☐indicate amount: €______please detail and justify if more than 3 nights are required in space below:
Information about accommodation can be accessed via the EPAUP website:

Amount of funding requested in total / €
Percentage of overall budget sought / 100%
4. Educational Event Details
Title / The 20th Annual Meeting of European Pressure Ulcer Advisory Panel – Interdisciplinary teamwork and technological innovations: A winning approach to pressure ulcer management
Dates / Start date: 12/09/2018
End date: 14/09/2018
Location / City: Rome
Country: Italy
Venue / Name: Angelicum University Congress Center,
Address: Pontifical University of Saint Thomas Aquinas, Rome, Italy
Objective of the Educational Event: please provide a detailed description of scope, purpose and anticipated outcome of the programme. / The conference theme is ‘Interdisciplinary teamwork and technological innovations: A winning approach to pressure ulcer management’ and incorporates:
  • Innovations in pressure ulcer prevention and treatment
  • Multidisciplinary approach in pressure ulcer prevention and treatment
  • Neonatal and pediatric pressure ulcer management
  • Incontinence-associated dermatitis
  • Negative pressure wound therapy
  • Biomechanics and aetiology
  • Telemedicine for remote pressure ulcer management consultations
  • Public and patient involvement in pressure ulcer prevention and treatment
  • Role of nutrition in pressure ulcer prevention and treatment
  • Dermatological, plastic, reconstructive surgery for pressure ulcers
  • Medical device related pressure ulcers
  • Repositioning for pressure ulcer prevention
  • Dressing and dermal substitutes selection
The full programme can be found:
Targeted audience by the Educational Event / International
5. HCPs Participation at the Educational Events
Please describe the application procedure and criteria based on which the beneficiaries of the grant will be selected / ☐ Applicant provides clinical leadership for PU prevention/treatment (e.g. TVN, Ward Manager, PU Link worker/champion)
☐ Other – specify
Please provide the name and/or position of the person who is responsible for selecting the HCPs to attend the Educational Events / ☐ Manager submitting application
☐ Other - Specify name and position below:
6. Payment details: (may be completed after approval)
Details of personnel responsible for financial controls over grant funds (e.g. applicant’s financial department) / Name:
Email address:
Bank account details
(This must be an account in the name of the body making the application and not an individual) / Bank name:
Bank country:
Account holder:
IBAN number:
BIC or SWIFT Code:

To be completed by the Manager submitting the application

I declare that:

This form was completed on behalf of the requesting organisation;

The information provided in this form and supporting documents is true and accurate;

The grant request is not implicitly or explicitly linked in any way to past, present or potential future purchase, lease, recommendation, prescription, use, supply or procurement of the Company’s products or services.

Date______

Name ______

Signature______

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