Journal Clubs and Rounds application form

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Briefly outline your funding request (75 to 200 characters)

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The amount should be inclusive of all fees related to the event, as per the detailed budget breakdown.

If your request is less than 45 days away, please e-mail [email protected] to obtain a PDF version of this application form, as you will not be able to submit your application through the Web site.

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Migraine
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Have funds been solicited from other sources? *

YES NO

The required documents to be attached are as follows:

Signed and dated letter of request on your organization’s letterhead including objectives, agenda and the number of events;
Detailed budget breakdown;
Article of Incorporation (or any legal document attesting of your entity’s legal status).

Failure to attach requirement documents may result in the rejection of your request.

ATTACHMENTS *

Please upload a valid attachment type with maximum size of 25MB. If you continue having issues, please e-mail your letter of request directly to [email protected].

Allowed File Types : PDF, Word, PowerPoint, Excel

The application hereby confirms that any of its managing members, do not have any actual, or potential conflict of interest with AbbVie or Allergan *

I have attached all the required documents (signed and dated letter of request on the organization’s letterhead containing the objectives and agenda, a detailed budget breakdown, and an article of incorporation or any legal document attesting to the entity’s legal status). *

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Journal Clubs and Rounds application form

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