Endorsement Application Form

The following application form for Endorsement of the Advanced Prostate Cancer Consensus Conference – APCCC Satellite – has to be filled out and submit at least one month prior to the planned event by clicking the submit button below.

To complete your application you must send the following documents to info@apccc.org :

1) Scientific programme (final or preliminary )
2) Selected APCCC Questions

Please indicate your MEETING below:

Academic purpose ONLYWith Industry SponsoringPurely Industry Sponsored

Title of event

Date and venue of event

Official website of event if available

Sponsor of the event

Which member of the APCCC panel is involved?

Please indicate if you wish to:

Use ALL original APCCC Question Use A SELECTION of the original APCCC Questions Use APCCC Questions with modified options Adapted version of APCCC Questions for countries with limited resources

Event descripiton:

What is the focus and aim?

Please include invited speakers, main topics and attach final/preliminary program

Targeted participants

How is the event funded? Please provide details of sponsoring (if applicable)

Applicant Surname/Last Name

Applicant Given Name/First Name

your-email address

Invoice address:

Organisation

Street

P.O Box

Zip code, City

Purchase Order No.

VAT No.

Date

Signature