Individual Funding Request

Please complete the form below giving as much detail as possible. Most of the fields are required.

Please note that payments cannot be made to individuals - only to third party suppliers. Applicants cannot be reimbursed for payments already made in association with an educational event.

Please explain how this support will benefit your patients.
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In a move towards greater transparency, you are aware that A. Menarini as an IPHA pharmaceutical company, is required to publicly disclose this payment. We are fully committed to transparency with the aim of building better relationships with stakeholders. This disclosure will be made on www.transferofvalue.ie, a platform hosted by IPHA within 6 months of the end of the year in which the transfer takes place. You can contact us to exercise your rights of access, correction or deletion regarding your personal details in relation to ToV by sending an email to ireland@menarini.ie. More information can be found in the transparency section of www.menarini.ie.
You are not making a claim from any other party in relation to the support you have requested from A.Menarini in this application form
Any support given will be used solely and fully for the intended purposes outlined above.