Conference and Course Grant Application Form

Consent for storing submitted data *

Yes, I give permission to store and process my data

See our Privacy Policy listed on our website.

First Name *

Surname *

Email *

Daytime Phone Number *

Your preferred number, can be a mobile

Current place of work *

Hospital, university, company etc. We do not need the address

Membership number

Please leave blank if you can't find it

Provide details of the conference/event *

Explain how attendance will benefit you and your department *

Funding Requirement *

Provide full details of the costs: UK Travel, Overseas Travel, Accommodation, registration fees, other costs and include details of other sources of funding.

Value of grant requested from IPEM in £ *

Attach statement of support from the Head of Department or equivalent *

The statement should include the name, organisation, designation and email address of the supporter. Must include how attendance at the event will benefit both the department and the applicant and where matched funding is coming from.

Upload attachments you wish to submit to support this application. *

For example. CV, copy of invite to speak, abstract accepted, matched funding from another source