Application Form for Support from the IOMP
Professional Relations Committee (PRC) for
Meetings on Professional Matters

1.         Title of Meeting :

2.         Location :

3.         Dates :

4.         Host Organization :

5.         Other Collaborating Organizations :

6.         Meeting Objectives :

7.         Meeting Director(s) :

8.         Expected Number of Participants :

9.         Countries expected to be involved :

10.       Proposed Faculty :

11.       Total Budget :

12.       Sources of Support :

13.       Requested support from IOMP :

14.       Address for correspondence :

            Telephone :                                                   Facsimile :

            e-mail :

15.       Application Submitted by :

             Signature :                                                     Date :