ECTRIMS Programme Support Application, page 1

ECTRIMS has limited funding available annually to support scientific and clinical programmes organised by others that are consistent with the ECTRIMS mission of supporting information exchange related to multiple sclerosis (see To apply for funds, this form should be submitted in a timely fashion – well before the anticipated programme – to the ECTRIMS Secretariat for evaluation.

In general, funds are available only annually (i.e., not for multiyear funding for recurrent programmes) and programmes that receive support from multiple sponsors (rather than relying solely upon ECTRIMS) are preferred; requests for support should be modest, given the limited funds available. Funds may be used for any programme-related purpose, but details must be provided.

ECTRIMS will review the application for funds upon receipt and make a timely decision. Our ability and willingness to support a programme organised by others will depend upon availability of funds, relevance and scope of the proposed programme, involvement of other sponsors, and, when relevant, history of past programmes. Support for a programme in any given year will not guarantee support in subsequent years. Finally, ECTRIMS reserves the right to provide support at a different level than that requested by the programme sponsor.

Please provide the information requested below, save this document on your computer drive and when you are ready, submit it by email, along with any appended materials, to the ECTRIMS secretariat at .

Programme Support Application

1. Name of Programme:

2. Proposed date of Programme (dd/mm/yr – dd/mm/yy) -

3. Location of event or meeting: City: Country:

4. Name and Address of Sponsoring Organization for the Programme:

Name of Organization:

Address 1:

Address 2:

City and Postal Code:

Country:

Sponsoring Organization web site, if any:

Name of Primary Contact Person:

Telephone for Contact Person(country/city/number):

Email for Contact Person:f

5. Purpose of Programme:

6. Intended Audience (anticipated attendance number, type of individual, etc):

7. Is this Programme run annually or is this a one-time event (check one)?

  • Annual
  • One-time event

If the Programme is run annually, where and when was the LAST programme?

City, Country:

Date of last programme (dd/mm/yy):

  1. What is the projected budget for this Programme?
  • Total Budget (€):
  • Budget will be used for what purposes? (examples: housing, travel, food/beverage, speaker honoraria, administration costs, others (list all categories): h
  1. What amount of funds are being requested of ECTRIMS (€):

ECTRIMS funds will be used for which budget categories?

Date by which ECTRIMS funds are required to be received (dd/mm/yr)

Bank Transfer Information for transmitting funds, if awarded:

Account Name:

Account Number: 3

Bank:

Bank Branch:

Bank Routing Number:

Swift Code:

Name of person to be notified if ECTRIMS funds will be made available:

Name:

email address:

  1. What other sources of support are available for this Programme:
  • Funds already received for the Programme (Amount in €; Source):
  • Funds applied, but not yet received (Amount in €; Source):
  1. Please provide a detailed Programme Agenda (topics, speakers invited, etc). Either append Agenda to this application OR provide a web site where the detailed Programme Agenda can be found:

Programme Agenda appended here OR

Programme Agenda can be found on the Sponsor web site

  • URL at which Programme Agenda can be found:
  1. Name of person completing this application:

Contact information in case of questions:

telephone (country/city/number):

email address:

Date of submission of application (dd/mm/yy):

PLEASE PROVIDE ALL REQUESTED INFORMATION, SAVE ON YOUR COMPUTER AND WHEN READY, EMAIL THIS FORM AND ANY RELEVANT ATTACHMENTS (FOR INSTANCE PROGRAMME AGENDA) TO THE ECTRIMS SECRETARIAT AT