Bursaries for Patients and Carers 2018 Title (required) ---Mr.Miss.Ms.Mrs.Dr.Prof. First name: (required) Last name: (required) Address: (required) City/town: (required) County: Postcode: (required) Daytime telephone: (required) Mobile: (required) Email: (required) How many NCRI Conferences have you attended? 01234567891011 Please select your role on the NCRI (Please select all options that apply): Consumer Forum memberConsumer member on a Clinical Studies GroupConsumer member on a Clinical Studies Group SubgroupConsumer member on CTRadOther NCRI Group or initiative If "Other" please specify below: There is a high demand for NCRI bursaries. To help us ensure we get maximum benefit from a limited budget, it is important that we understand your reasons for wanting to attend the Conference. Please provide a brief explanation of how you will benefit from attending, including any specific training or learning outcomes you hope to achieve. (150 words maximum): How you will use the knowledge and experience gained to contribute to your NCRI work. (150 words maximum): How you will use the knowledge and experience gained to contribute to work as a consumer beyond NCRI (150 words maximum): Various levels of bursary are given which include registration (single or multiple days), travel and accommodation. Applicants are encouraged to also explore other possible sources of funding and to look at the Conference programme to decide which days are most relevant to their needs and interests. Please specify what additional support you are able to obtain and from which organisations (e.g. local Consumer Research Panel, Trial Management Group, Clinical Trials Unit, charity or networking group): Please take a look at the Conference programme to decide what sessions are applicable to you before submitting your bursary application and therefore which days you wish to attend. Sunday 4th NovemberMonday 5th NovemberTuesday 6th November Please indicate which nights you will require overnight accommodation (please select all options that apply): Sunday 4th NovemberMonday 5th November The closing date for bursary applications is 12:00pm, Thursday 10th May 2018. You will be notified whether or not your application has been successful week commencing Monday 21st May 2018. You will then be given instructions on how to register online, which will also enable you to select which sessions you wish to attend. Nearer the time of the Conference you will also be sent a pack containing further information. Please ensure you have read through the terms and conditions thoroughly (see below). If you have any enquiries in regards to the bursary scheme please contact the NCRI Research Involvement Officer or call 0203 469 6121. Terms and conditions Full or partial bursaries may be awarded which include Conference registration, accommodation, complementary refreshments offered at the Conference, Consumer Bursary Holders’ Welcome Buffet and Conference social event. Attendance to the Welcome Buffet and Conference social event is expected, as part of the Conference Bursary. Given this, alternative dining arrangements during these events will not be reimbursed. No honoraria or attendance fees apply and travel expenses within the UK will be reimbursed according to the NCRI Conference Travel expenses policy. Please note that this is NOT the same as the NCRI Expenses Policy. For budget tracking purposes all travel must be booked and costs incurred confirmed to the NCRI Research Involvement Officer no later than Friday 7th September 2018. Accommodation: All hotel accommodation will be booked by the NCRI Conference and Events Team according to the information provided on your conference registration form, which needs to be completed after confirmation of your bursary application and will be within easy reach of the Conference venue. The bursary does not cover hotels booked independently. Accommodation is provided on a bed and breakfast basis and bursary holders will be liable for any ‘extras’ (e.g. telephone calls, room service, etc). Accommodation is based on single occupancy and is fully funded for bursary holders only. If the bursary holder travels with a carer the carer’s accommodation might need to be funded separately. Amendments/cancellations to your accommodation booking must be made no later than four weeks prior to the Conference; please contact firstname.lastname@example.org in this instance. Any amendments/cancellations after this will incur a charge to the bursary holder, unless in the case of extenuating circumstances, which can be discussed with the Head of Clinical Research Groups. Conference registration: Registration includes attendance at all sessions on the specified day(s). Lunch is provided on Monday and Tuesday. Beverages will also be available during refreshment breaks. Bursaries will also include the Conference social event on Monday evening. Feedback survey: Completion of the feedback surveys after the Conference is mandatory and it is important for the development of our processes and future Conferences. Questions related to the bursary scheme are embedded within the electronic feedback survey. It is mandated to complete and submit the form as soon as possible after your attendance at the Conference and prior to you submitting any expenses claim. Expenses claims will be approved only after the questionnaire has been completed. Bursary Holders are also required to complete feedback survey forms for specific consumer activities and events. Claiming your expenses: All claims must be made using the relevant form (via the NCRI Research Involvement Officer) within two months of the last day of the Conference (i.e. by Monday 1st January 2019). Late claims will not be reimbursed. Please allow 30 days for payment of your expenses. The NCRI will not pass on your details to any outside organisation without your prior written permission, however, your name and affiliation will appear in the delegate list in the consumer pack and participants list. I have read and understood the terms and conditions.