International Travel Grant

Consent for storing submitted data *

Yes, I give permission to store and process my data

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First Name *

Surname *

Email *

Daytime Phone Number *

Your preferred number, can be a mobile

Current place of work *

Hospital, university, company etc. We do not need the address

Membership number

Please leave blank if you can't find it

The case for support (Maximum 3 x A4 pages) *

Should include: • brief details of the work of the candidate in relation to the proposed visit(s) • details of the proposed work area justifying why there is a need to bring the relevant expertise into the UK, or what the opportunities are for collaboration. • details of the centre to be visited including names and brief details of the main contacts • the proposed plan on return to the UK for taking forward the work

Explain how attendance will benefit you and your department *

Funding Requirement *

Provide full details of the costs: UK Travel, Overseas Travel, Accommodation, registration fees, other costs and include details of other sources of funding.

Duration of visit in days *

Value of grant requested from IPEM in £ *

Upload attachments you wish to submit to support this application. *

For example. CV, details for the course/conference, matched funding from another source