Application for Level 4 – ASGBI Endorsed Events

Application for Level 4 - ASGBI Endorsed Events

For: External events seeking ASGBI endorsement only (no ASGBI faculty or delivery role
Section 1: Event Overview
1. Event name*
2. Event organiser / organisation*
3. Main contact name*

First NameLast Name
4. Email address*
example@example.com
5. Phone number*
Please enter a valid phone number.
6. Proposed event date(s)*
7. Format*

In personOnlineHybrid
8. Location (if applicable)
9. Expected number of participants*
10. Is this a recurring event?*

YesNo
11. If yes, attach a summary of previous feedback/evaluation

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Section 2: Educational Content
12. Brief description of the event*
13. Learning objectives*
14. Target audience*

Consultant or equivalentST3 - ST8 or equivalentCT1 - CT2 or equivalentFY1 - FY2 or equivalentOther
15. Pre-requisites (if any)

Section 4: Programme Details

Attachments required
16. Please attach a full programme, including named faculty

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17. If you are unable to provide a full programme document, outline the details below
18. Details of any commercial or industry support / sponsorship
19. Conflict of interest summary (for all speakers/faculty)*

20. Please indicate below that the following event best practices have been considered*

	Yes	No
Diversity of faculty representation
Accessibility for attendees
Parent/child facilities available/nearby
Dietary/religious/medical requirements catered for

Section 6: Declaration
21. Tick to acknowledge the following*

I confirm that the information provided is accurate and completeI confirm that all relevant conflicts of interest have been declaredI request formal endorsement by ASGBI for this eventI understand that this application must be submitted at least six weeks before the event
22. Please use this space to include any further details you would like to include in support of your application
Should be Empty:

Application for Level 4 - ASGBI Endorsed Events