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REGIONAL CLINICAL CASES MEETING GRANT APPLICATION Regional Clinical Cases Meeting grants provide funding to support institutions to run their own regional clinical endocrine case meetings. Meetings organised using the grant should focus on raising awareness of endocrinology as a discipline and on attracting clinicians and nurses into the speciality. Meetings should provide regional opportunities to share recent interesting and notable cases and to discuss these with colleagues, as well as a forum for early career endocrinologists to present clinical cases. The Society encourages organisers to provide the opportunity for delegates from outside the host institution to attend. Organisation of a meeting using the grant is the responsibility of the successful grant awardee (the meeting organiser). The Society will provide the following to Regional Clinical Cases Meeting organisers: Funding of up to £2000 per grant Assistance in publicising the meeting via the communication of information to Society members and publication on the Society website The Society logo for use in event material Society promotional literature normally a week in advance of the event. Terms and conditions: By applying, the organiser undertakes to comply with the following requirements: The meeting should be endocrine-related The meeting is to be badged ‘supported by a Society for Endocrinology Regional Clinical Cases Meeting Grant The organiser takes responsibility for the planning and logistical running of the meeting The organiser is to provide appropriate SfE visibility (e.g. on event-related literature/printed materials, website and other appropriate material). The organiser is responsible for advertising the meeting regionally, as well as internally. Early Career clinicians are to be especially encouraged to attend A report suitable for publication in The Endocrinologist/on the Society website is to be provided within 1 month of the meeting. The Society reserves the right to publish successful applicants’ final reports. The final report should include attendee details including number and where possible their career stage and interest area. Keynote speakers may be approached by the Society to submit a review to one of the Society’s journals The successful applicant will recognise the award on their department website with a link to the Society website for a minimum of 6 months after receipt of the grant Encourage those presenting clinical cases to submit their clinical case to the journal Endocrinology, Diabetes and Metabolism Case Reports (www.edmcasereports.com/). Grant awarding: The Society will not fund an individual centre more than once every three years Funds awarded are final and do not include overheads Funds are awarded on the understanding that they are used for the purpose stated in the application. If support is obtained elsewhere or any part of the grant is unused, the balance will be refunded to the Society Grants cannot be awarded retrospectively The decision of the Grants Panel is final and not subject to appeal Eligibility: Full Members may apply if they hold a minimum of one year’s membership. Clinician-in-Training Members may apply if they hold a minimum of six months’ membership. It is anticipated that the applicant will normally be an academic or academic-related staff member. If not, a letter of support is required by the principal investigator or clinical team leader. Value: Grant deadlines: Up to £2,000 per grant 15 April and 15 June REGIONAL CLINICAL CASES MEETING GRANT APPLICATION SECTION 1: Applicant details Name of applicant (block letters) ...................................................................................................................... Membership number ........................................................................................................................................ Name of Department ........................................................................................................................................ Name of Institution ........................................................................................................................................... Work address .................................................................................................................................................... Email address (work) ....................................................................................................................................... Telephone number (work) ................................................................................................................................ Position held (start and end date) .................................................................................................................... SECTION 2: Event details Event title .......................................................................................................................................................... Date of event .................................................................................................................................................... Venue ................................................................................................................................................................ Those presenting clinical cases are encouraged to submit their clinical case to the journal Endocrinology, Diabetes and Metabolism Case Reports (https://www.edmcasereports.com/). Number of expected delegates ......................................................................................................................... Profile of delegates eg, clinicians/scientists/both ............................................................................................. Rationale for the application - Outline summary of request and details of speakers and talk titles Please include details of any additional meeting programme, such as networking slots, benefit to Society members, particularly trainees/early career researchers, prospective members, oral presentations/case reports selected from abstract and poster sessions, career workshops, possible opportunities for media coverage etc: .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... Summary of costs (no more than 20% of total amount should be allocated to catering costs): Budget – approximate costs (if known): 1) Venue hire ....................................................................................................... 2) Catering........................................................................................................... 3) Speakers’ travel .............................................................................................. 4) Speakers’ accommodation.............................................................................. 5) Cost of social event if applicable .................................................................... Do you have any other funding relating to this meeting? ...................................................................... Yes/No If yes to above, please provide details .............................................................................................................. .......................................................................................................................................................................... .......................................................................................................................................................................... TOTAL COSTS: ................................................................................................................................................ The grant will be paid to an institutional account and we will contact you for details in the event that your application is successful. Details of any local sponsorship and support: Company: ............................................................................. Amount of expected sponsorship £: ............................................................................ ............................................................................. ............................................................................ ............................................................................. ............................................................................ Details of all Society and other grants awarded in the last 2 years ................................................................. .......................................................................................................................................................................... .......................................................................................................................................................................... Name and address to which Society promotional literature should be delivered .......................................................................................................................................................................... .......................................................................................................................................................................... SECTION 3: Details required from the Head of Department Confirmation that this application is correct, has my approval on behalf of the university/institution and acceptance of the Society’s terms and conditions: Name of applicant: ........................................................................................................................................... Head of Department: ........................................................................................................................................ Head of Department signature: ........................................................................................................................ Head of Department contact details: Name of Department ........................................................................................................................................ Name and address of Institution ...................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... Email address (work) ....................................................................................................................................... Telephone number (work) ................................................................................................................................ Please submit all parts of the signed application form electronically to [email protected] Incomplete applications will not be considered Office use only: Date received: Form complete (yes/no) HOD signature Yes/no Subs paid (year): Member from (mm/yy):