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* 1. Meeting Title

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* 2. Subject matter:

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* 3. Dates of meeting:

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* 4. Venue:

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* 5. Host Organisation:

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* 6. Please list the meeting objectives:

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* 7. Please list the names of the organising committee (including a note of those who are E-AHPBA members):

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* Upload any supporting documents for the organising committee here:

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* 8. Please provide a copy of the scientific programme including proposed faculty:

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* Upload any supporting documents for the scientific programme here:

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* 9. Will CME be provided to course attendees?

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* 10. If the meeting is accredited, please name the CME provider:

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* 11. Is the meeting international, regional or national:

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* 12. Please confirm the level of discount on registration fees offered to E-AHPBA members:

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* 13. Date of request:

Date / Time

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