DIA Europe 2019 - Patients Included Fellowships application

DIA Europe 2019 is an annual conference that brings together key thought leaders and innovators from the healthcare ecosystem including industry, academia, regulatory, government agencies, patient, and philanthropic organizations. They come from across all disciplines involved in the discovery, development, and lifecycle management of healthcare products and therapies. The meeting is intended to strengthen professionals’ understanding of the value of cross-discipline integration and to foster innovation for better health outcomes. For more information, read this article on the European Patients’ Forum newsletter.

This year's conference will take place at the Austria Center Vienna from the 5th to the 7th of February.

In order to include the patient representatives input in this dialogue, DIA Europe 2019 will offer up to five Full Fellowships and up to fifteen Registration Fee waivers.

·        Full Fellowship:

Includes round trip in economy class (plane) or 2nd class (train); up to 3 nights at one of the hotels within the DIA room block (room + tax); up to 3 days per diem for miscellaneous travel expenses; registration fee for the main meeting waived.

·        Registration Fee waiver:

Includes complimentary registration fees for the main meeting and 3 days per diem for miscellaneous commuting expenses.

To qualify for this scholarship, you must:

1.      represent/be a member of a non-profit patient organisation officially registered in the EMEA region;

2.      be familiar with activities related to medical products development, regulation and access, together with the policy landscape in Europe;

3. commit to disseminate outcomes from the meeting to your network.

Successful applicants are expected to:

- attend all days of the conference;

- afterwards, provide feedback on their experience in a one hour webinar taking place one week after the end of the event;

- contribute, through a written testimony, to an article for a DIA publication, following the conference.

Please complete this online application form to be considered for a Fellowship to attend the conference. In addition to the completed survey, you must provide a support letter from your organisation and a document attesting its NGO/non-profit status, which should be upload at the end of the form.

All applications must be submitted by Wednesday, the 5th of December 2018, 12:00 CET. Results will be communicated to all applicants by the 12th of December 2018.

For any further questions, please contact cathy.persidis@diaglobal.org

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* 1. Which fellowship are you applying for?

Full Fellowship

Registration fee waiver

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* 2. Please provide your personal contact information here:

Name and SURNAME

Organisation

Country

Email address

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* 3. Do you have specific accessibility requirements?

Yes

If yes, please specify

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* 4. Do you require assistance whilst at the meeting?

Yes

If yes, please specify

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* 5. Are you an EUPATI Fellow?

Yes

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* 6. How are you associated with your organisation?

Active Member

Volunteer

Board Member/ Leadership

Staff

Advising in Pharma/Regulator/Reimburser

Speaker/ Representative at events

Other (please specify)

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* 7. What type of patient partner role best describes you? (Check all that apply)

Patient

Patient Advocate/ Representative

Patient family member/ Caregiver

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* 8. How would you describe your experience within your organisation?

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* 9. Which best describes the disease area of your organization?

Common disease(s)

Rare disease(s)

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* 10. What population does the disease(s) affect most? (Check all that apply)

Male

Female

Adults

Children

Seniors

Specific Ethnic or Racial Group

Other (please specify)

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* 11. Which best describes the priorities of your organization? (Check all that apply)

Research

Advocacy & Policy

Patient/Caregiver support

Education

Access to treatment

Other (please specify)

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* 12. How do you believe attending DIA Europe will help your organization, patient community, and/or you?

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* 13. How can you support DIA reaching out to the wider patient community concerning the discussions and outcomes from DIA Europe?

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* 14. Please describe your experience/ understanding of medicines development, regulation and access.

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* 15. Please upload the support letter from your organisation:

DOCX, DOC, JPEG, JPG, PDF, PNG file types only.

Choose File

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* 16. Please upload the document attesting the NGO/non-profit status of your organisation:

DOCX, DOC, JPEG, JPG, PDF, PNG file types only.

Choose File

Thank you for completing the online application! If you have any further questions, please contact cathy.persidis@diaglobal.org.

By submitting this form, you hereby agree that DIA may collect, obtain, store and process your personal data that you provide in this Form for the purpose of the Patients Included Fellowship application.
For more information, please consult DIA's Data Management Policy here.

We look forward to seeing you at DIA Europe!