Fiona & John Mallard Trust

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First Name *

Surname *

Email *

Daytime Phone Number *

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IPEM Membership Number (if applicable)

Current place of work (Full address) *

Hospital, university, company etc.

Which conference would you like to attend? *

EFOMP ECMP 11-14 September 2024

IPEM STEF 9th to 10th October 2024

Explain in no more than 300 words why attendance at this conference will enhance your career *

Title of paper to be presented *

Any other involvement in conference e.g. chairing a scientific session

Referee details (Name, connection to applicant and contact details) *