Scientific Event proposal form

Request for the following support *

Advertise in calendar on ESCMID website (www.escmid.org/calendar)

Endorsement (ESCMID lends logo to event and advertises event (www.escmid.org/calendar)

Delegates attendance grants up to EUR 5’000 in total per event (covering registration only, not accommodation/travel costs) for multi-state events

Sponsoring of two ESCMID speakers up to EUR 5’000 in total per event for national events (events held in national language)

Do you plan any support from the sponsors? *

No

Yes (please specify how many sponsors you plan to secure)

Please note that ESCMID cannot support any event with only one sponsor. Therefore, at least two sponsors are required in order to apply for ESCMID support.

Your personal details

First Name *

Family Name *

City *

This field must be filled!

Phone (including country code) *

Email *

Event details

Event name *

Size of the event *

Expected number of participants (excluding faculty)

Event start date *

Event stop date *

Event website *

Event city/country *

More venue details

Please upload the event programme (including all talks, faculty members and their nationalities) *

Choose File

No file chosen

Event organiser *

ESCMID Study Group

ESCMID affiliated society

Other

Please indicate the name of the Study Group / Affiliated Society in the fields below.

ESCMID Study Group

ESCMID Affiliated Society

Event secretariat and/or agency:

Name *

Street Address *

City *

State / Province / Region *

Postal / Zip Code *

This field must be filled!

Phone (including country code) *

Fax (including country code)

Email *

Don't fill this field!