Endorsement Submission

Please select the submission type:

New submission (£450 exc. VAT)

Expired submission (£450 exc. VAT)

Revised application (£225.00 exc. VAT)

Name of organisation:

Organisation address:

Address Line 1

Address Line 2

City

County

Postcode

First name:

Surname:

Job title:

Telephone number:

Email address:

Does your activity promote a pharmaceutical product or service?

Yes

No

Please include further information below:

Is your education for a Regional or National audience?

Regional

National (UK)

Please select the type of education you are seeking endorsement for:

Event

Training material/Training course

eLearning

Event title:

Event description:

Start date

Start time:

End date

End time:

Total learning hours (excluding breaks):

How will the event be delivered?

Live

Virtual

Hybrid

Training material title:

Training description:

Total learning hours (excluding breaks):

Format of training material:

Live

Remote

Hybrid

Access details (if applicable):

Login

Password

I confirm that trainers preparing / delivering the material have the necessary qualifications to do so.

eLearning title:

eLearning description:

Approximate learning hours (excluding breaks):

Access details (if applicable):

Login

Password

Please list all of the questions and answers on the elearning module in the text box below:

Would you like to be contacted about promoting your resource on the PCWHF website?

Yes

No

Submission Details

List the speakers/writers/contributors:

Please state all teaching methods that will be used within the programme:

Will there be an opportunity to validate the learning that will take place?

Yes

No

Please give details:

Will an attendance certificate be given?

Yes

No

Please upload a copy of the attendance certificate for review

Choose file

Please upload a copy of the agenda, programme, resource for review:

Choose files

Intended target audience:

Suggested level of education:

Is there a fee to delegates?

Yes

No

How much is the fee?

If discounts are offered, please state:

Please state who has funded the creation of the event/resource/course:

Learning Objectives

Please list the learning objectives of your event/resource/course:

What specific skills will the learners acquire from the education?

Submission Summary

I hereby confirm that the information on this application form is correct and that I, or my organisation, owns or has been given permission to use the educational material I am submitting.

Signature:

Date of submission:

By completing this form, the user acknowledges that they must not promote any materials as being endorsed by the PCWHF until they receive email confirmation of endorsement.

By submitting this form, the applicant understands that their information will be used by PCWHF and co-organiser E4H inline with the PCWHF privacy policy and the E4H privacy policy in order to contact them about the submission. All data will be processed and handled inline with the General Data Protection Regulation Act (GDPR)

Payment

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