Event support form - Quebec Pain Research Network

Last Name(Required)

First Name(Required)

Email(Required)

Name of the event(Required)

Amount of the requested support(Required)

Anticipated expenses(Required)

You can add a budget as an attachment and indicate your current sponsors and anticipated expenses

Event visibility(Required)

Who are the QPRN members involved in the organizing committee?(Required)

Who are the non-RQRD members involved in the organizing committee?

Who are the QNJPI members involved in the organizing committee?(Required)

Does the organizing committee include a patient partner?

How many participants do you anticipate(Required)

Expected number of QPRN members attending?(Required)

Expected number of QPRN members presenting?(Required)

How do you encourage the inclusion of knowledge users(Required)

How do you encourage student involvement in the organization?(Required)

Please attach supporting documents

Max. file size: 5 MB.

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