ControversiesChallengesConsensus
CX 2017 Grant application 2017-02-06T17:02:14+00:00

CX 2017 Grant Application Form

On behalf of BIBA Medical Ltd, with the support of W.L. GORE & Associates, we invite you to attend the Charing Cross Symposium 2017 at London’s Olympia.

Successful applicants will have the cost of registration and hotel paid for, as well as having travel costs reimbursed after the event.

To apply, please complete the online application form below on or by Friday 17th February.

  • Requests will be reviewed by a Grants Review Panel
  • Please complete all sections as failure to do so could result in a rejection
  • Completed forms should be submitted no later than 1700 GMT on Friday 17th February
  • Late submissions will not be considered
  • The grant will cover full CX registration (access-all-areas), up to 3 hotel nights (single occupancy, including breakfast and VAT) at one of the recommended nearby hotels (hotel will be allocated and booked by BIBA Medical and will be subject to availability and price), and travel reimbursement (economy flight/train up to the value of £500)
  • Successful applicants must register using an online code no later than the 1st March
  • Travel must be booked by the individual and receipts sent to Dawn Nicholls – dnicholls@bibamedical.com – no later than the 5th April
  • Travel will not be reimbursed in the event of a no-show
  • We request that successful applicants complete a short feedback questionnaire during or after the event

Title (required):

First Name (required):

Institution (required):

Surname/Family Name (required):

Job title (required):

Speciality (required):

Other speciality:

Address details

Address Line 1 (required):

Address Line 2:

City/Town (required):

County:

Country (required):

Post code/Zip Code (required):

Email address (required):

Telephone number (required):

Mobile/Cell number:

Have you ever attended CX before?
YesNo

If yes, how was your registration funded?
Self-fundedSupported by a companySupported by an institutionFacultyOther

Please let us know how you will benefit from attending CX:

Please let us know your main areas of interest at the event: