IDEOM Stakeholder Application

International Dermatology Outcome Measures (IDEOM) is a non-profit organization seeking to develop and validate measures throughout dermatology. IDEOM strives for the establishment of patient-centric outcomes to enhance the research and treatment of dermatological conditions. IDEOM seeks to bring together physicians, researchers, government agencies, pharmaceutical companies, payers and patients from around the globe to develop and validate measures throughout the field of dermatology.

To become a stakeholder with IDEOM, participation in Delphi surveys, web conferences, workgroups, and in-person meetings will be required. IDEOM provides a travel bursary for all stakeholders, with the exception of our industry and payer stakeholders.

Please complete this application and submit a letter of interest of developing outcomes in dermatologic conditions or your personal experience. Please also submit a CV (patients need not submit a CV).

Please contact Amanda Pacia, IDEOM Association Manager, at amanda@dermoutcomes.org with any questions.

Name

First Name Last Name

Degree

Email

example@example.com

Academic Title

Institution/Company

Mailing address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Please enter a valid phone number.

Type of Stakeholder category you would like to participate in:

Which workgroup(s) are you interest in participating in?

Psoriasis Psoriatic Arthritis Hidradenitis Suppurativa Acne Actinic Keratosis Pyoderma Gangrenosum Vitiligo

Name of person who recommended you (if anyone):

List any significant publications in dermatology (if applicable):

Upload CV

Please explain your interest in IDEOM: