QuickStart at EADO2018

6- 9th November, Barcelona

Do you want to learn more about Melanoma and how to successfully educate others about what you have learned?

ongoing DEADLINE

closes 8th October

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* 1. Your contact information

Name

Address

City/Town

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. You are applying for

a fully supported place at the QuickStart (workshop participation, travel support up to 350 EUR, accommodation and meals)

workshop participation only (so you will cover travel and accommodation yourself)

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* 3. What is your profession?

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* 4. The Workshop and Conference is in English - what is your level of English?

Native English Speaker

Very Good written and Spoken English

School Level English

Poor English but happy to try

No English

Native English Speaker

Very Good written and Spoken English

School Level English

Poor English but happy to try

No English

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* 5. Your relationship to Melanoma

	Stage 1	Stage 2	Stage 3	Stage 4	n/a
I am a Melanoma patient	I am a Melanoma patient Stage 1	I am a Melanoma patient Stage 2	I am a Melanoma patient Stage 3	I am a Melanoma patient Stage 4	I am a Melanoma patient n/a
I am the carer of a Melanoma patient whose disease is in	I am the carer of a Melanoma patient whose disease is in Stage 1	I am the carer of a Melanoma patient whose disease is in Stage 2	I am the carer of a Melanoma patient whose disease is in Stage 3	I am the carer of a Melanoma patient whose disease is in Stage 4	I am the carer of a Melanoma patient whose disease is in n/a
Other	Other Stage 1	Other Stage 2	Other Stage 3	Other Stage 4	Other n/a

If other, please specify

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* 6. Are you involved with a Melanoma patient advocacy group?

Name of the group

Country

Website

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* 7. Which communication channels do you use in Melanoma- tick all that apply

facebook

twitter

snapchat

slack

messenger

mailing list

blogs

vlogs

youtube

online publishing platform- such as issuu

Other (please specify)

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* 8. Please list all Melanoma patient forums you are involved in and/ or if you are planning to start a new one

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* 9. Please tell us why you are interested in attending EADO in particular

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* 10. With whom and in which format do you intend to share what you will learn at EADO?

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* 11. Is there anything else you would like us to know ?

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* 12. I have read and accept the Participants Agreement.

Yes

PARTICIPANTS AGREEMENT

Participants will be selected from those who wish to be ACTIVELY involved in helping Patients with Melanoma, but who are new to advocacy and who fulfil our language and nationality criteria - selection decisions will be final.

MPNE will supply accommodation, meals and public transport cards from Tuesday evening, the night before the Workshop, until the close of the Conference sessions on Friday.

Travel will be reimbursed up to 350 Euros - this amount includes all travel expenses - train, flight, car- for economy/ 2nd class travel to and from Barcelona. Participants will be responsible for booking their own travel and they will be reimbursed after attending the full conference on completion of the reimbursement form together with travel receipts.

INSURANCE:
MPNE bears no responsibility for untoward events in connection with, before, during and after the conference. Participants are advised to take out their own personal and travel insurance coverage.

ATTENDANCE:
Participants must attend the Workshop and the Conference for the 3 days.

Please note we will inform you if your application has been successful by the 10th October and you will then receive further logistical information - PLEASE DO NOT BOOK TRAVEL/FLIGHTS UNTIL YOU HAVE BEEN INFORMED OF YOUR SUCCESSFUL REGISTRATION.

We are looking forward to seeing you in Barcelona!
Gilly, Violeta and Bettina