Please complete this form to be in with a chance of winning a sponsored place to attend the Cochrane Ireland and Cochrane UK 2020 symposium.
Please note, you are only eligible to attend if you are based in the UK or Ireland.

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* 1. Please provide your:

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* 2. I am applying as a...

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* 3. If you are a student, please tell us what course you are studying, the university you attend, and a little about your interest in evidence-based health care. Otherwise, please enter N/A.

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* 4. If you are a health professional, please state your role and tell us about your research interests. (Up to 200 words). Otherwise, please enter N/A.

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* 5. If you are a consumer, please tell us a bit about yourself and your experience as a health service user. (Up to 200 words). Otherwise, please enter N/A.

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* 6. Please tell us why are you interested in coming to the symposium and what you hope to get out of it. (Up to 200 words).

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* 7. Please tell us your estimated travel costs to and from the symposium venue (The Gibson Hotel, Dublin)

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* 8. Do you have any special requirements, travel or otherwise?

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* 9. Do you have any other comments?

The deadline for applications is Friday 6th March 2020 at midday. Applicants will be notified by Friday 13th March.

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