Group Sponsorship Application

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

Please detail the meeting objective - giving particular attention to how patients will benefit directly and/or how the quality of patient care will be improved as a result of the meeting.
Please Note that only Physicians, Nurses,Pharmacists and Dentists are considered HCPs
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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.
Is Menarini the sole sponsor? If not, please enter details of other sponsors below.
If requested by A.Menarini you will provide invoices and receipts related to this request to verify compliance with the terms of this Agreement.