Congress sponsorship application

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Select therapy area *

Select a gastroenterology meeting *

Select a hospital meeting *

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Select a rheumatology meeting

Application details

Title *

Full Name *

Job Title *

If 'other' please specify your job title: *

Hospital / GP practice / academic institution *

Are you a member of an Association relevant to the congress you wish to attend? *

Phone number *

Email address *

Eligibility criteria

Pfizer is considering providing you with direct financial support in relation to this meeting. As part of Pfizer's review, and in accordance with Pfizer's policies and applicable legal requirements, we need to understand whether you hold a position in which you have decision making authority or official influence over (i) the approval, reimbursement, prescribing, purchasing or recommending of any Pfizer product or (ii) any act that would benefit Pfizer's business activities. To facilitate this determination, please answer the questions set out in this questionnaire.

Please read the Privacy Policy, which provides important information regarding the purposes for which Pfizer will use the information collected through the questionnaire and related diligence.

Do you have decision making authority or official influence over any of the following matters:

The approval/registration/amendment/variation/suspension/revocation/cancellation of a government-issued marketing or sales authorisation (product licence) for pharmaceutical products/other medicine/consumer healthcare products/Pfizer products? *

Yes

The government - imposed conditions under which healthcare products or medicines are imported/marketed/distributed/sold? *

Yes

The price/reimbursement/formulary listing of healthcare products or medicines? *

Yes

The inclusion of vaccines in a national/regional immunisation programme, drafting/approval of legislation/regulations or government funding/purchasing of vaccines or the approval of any disease/conditions/vaccines related to such immunisation programmes? *

Yes

The grant or renewal of a government issued permit or licence? *

Yes

The government approval or authorisation of (i) clinical trials or (ii) other research and development undertakings? *

Yes

Any other official government matters or activities which may impact Pfizer's business or products? *

Yes

Checkbox 1 *

I confirm the above certification

Checkbox 2 *

I confirm that I am a HCP practising within the UK and this is my only application in this calendar year (Jan-Dec) to Pfizer for support with registration fees to attend a third party meeting

Checkbox 3 *

I confirm that I am applying for support with registration fees for this meeting as (i) I have a strong interest in this therapeutic area; and/or (ii) I have a defined health need in my patient population relevant to this meeting and/or (iii) I have a desire to improve services and clinical effectiveness in this area

Checkbox 4 *

I confirm that there is a clear link between the knowledge I will gain through attending this meeting, and the direct application to improving clinical practice and patient care. This funding is not requested for a predominantly personal benefit which would enhance my CV

Checkbox 5 *

I confirm that Pfizer will receive nothing in return for this support. I understand that this funding is not offered as an inducement to prescribe, supply, administer, recommend, buy or sell a Pfizer medicine. I have not been asked to attend any promotional meetings in relation to this application for support.

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