To: The Secretary General

Dear Sir,

We would like to request your valuable support for our event as per the following information:-

REQUEST FOR:
☐	Conference Support	☐	Workshop Support	☐	Training Program Support	☐	Health Education Program Support
Other (Specify):
SUPPORT TYPE:
☐	Financial (Amount (AED): )	☐	Logistics
1.	1.
2.	2.
3.	3.
BRIEF ABOUT THE EVENT
Name of the Event?
Venue:
Event Status:	International	Regional	GCC	Local
No of Speakers	International: Click Here	Regional: Click Here	Local: Click Here
Workshops:	None	Pre.	Post	Pre. & Post
Scheduled dates:	From.	To.	Website:
ACCREDITATION
CME Hours	No of CME Hours
Accreditation Institute:	Name:
Phone:	Fax:	P.O.Box:
Country:	Website:
PARTNERS (in association with)!
1.	3.
2.	4.

EVENT OFFICIALS
Patron:
President/ Chairman	Contact:
Chairman Sc. Comm.	Contact:
ORGANIZING COMPANY:
Name:
Phone:	Fax:	P.O.Box:
Country:	Website:
OTHER INFORMATION
Expected Delegates:	Doctors: Click Here	Nurses: Click Here	Students: Click Here
Social Program:	Arranged	Will be	Not required	Advise needed
Exhibition?	Do you have an Exhibition? YES NO
Type of Exhibitors	Pharmaceuticals	Equipment’s	Government	NGOs	Banks
HOW OFTEN YOU ORGANIZE THIS EVENT?
Only Once	1st time	Annually	2 Years	3 Years	4 Years
DID YOU GET A SUPPORT FROM THE AWARD PREVIOUSLY?	Yes	No
If “Yes” Please specify?
REQUISITIONER
Name:
Contacts	Phone:	Email:
Organization	Name:
Phone:	Phone:	P.O.Box:
Website:
Signature: -------------------------