Application

Applications are now closed.

Please ensure all mandatory sections marked with an asterisk (*) are filled correctly and in the format requested. Please do not submit more than one application.

ESPE Science Symposium 2024 - Host application form

ESPE Science Symposium 2025 - Host application form

Activity name you are applying for

Section 1: Applicant and LOC Chair details

Name of applicant

Full name

Date of birth

Gender

Nationality

Degrees

(e.g MD, PhD etc.)

TextPresent position and institution

Please be advised that applicants who have been consultants for more than 1 year are not eligible

Work address

E-mail

Confirm E-mail

Telephone

(International code/ National code/ Number)

Chair of LOC/host applicant ESPE membership number

Section 2: Local Organising Committee details

Please enter the full names of each of the LOC

Separate with a comma

Section 3: Proposed topic

In no more than 300 words please describe how you will involve patient support groups / patient representatives in the organisation of the Science Symposium.

Please indicate if a patient support group can endorse your application, including the name and email address of the support group.

Section 5: Venue Details

Title of proposed Science Symposium

Venue where the proposed Science Symposium will take place

Section 6: Available dates

Preliminary Programme

Please include one session dedicated to the patient perspective, organised together with patient support groups / patient representatives. No more than 300 words

Please propose some dates for the Symposium

Section 7. Preliminary budget

Case for support

In no more than 300 words please explain why there is a need for a scientific symposium in the field of your proposal and why ESPE should support it

Please provide a preliminary budget to date and include the following information where possible:

Free delegates and speaker costs, venue/accommodation, catering (including dinner), registration costs/administration/materials etc., CME accreditation, any other additional costs, any other sources of funding

Section 4: Patient Involvement

Total budget

Section 8 . Contingency plan and budget for online hosting

Please outline your contingency plan for delivering the Science Symposium online, should this be required

Please provide a preliminary budget for hosting the Science Symposium online *

Quotes for hosting online meetings can be obtained by contacting [email protected]

Consent for storing submitted data

I confirm that all the information given on this form is my own and is correct