Sponsorship Request

Sponsorship Request Form 2026

Name of healthcare organisation*

Objectives of healthcare organisation*

Name of Secretary/ Head of healthcare organisation:*

No. of members/size of healthcare organisation*

As per the IPHA code the sponsorship amount will be declared publicly on www.transferofvalue.ie. Please provide us with the name of the healthcare organisation as it should appear on this website.*

Please provide us with the address of the healthcare organisation?*

Meeting name:*

Meeting date:*

Venue of event*

Objectives of the meeting:*

Sponsorship amount:*

Breakdown of what these costs cover?*

Bank name*

Bank account name:*

Bank branch*

IBAN Number*

VAT number*

Is A. Menarini Pharmaceuticals the sole sponsor or are there multiple sponsors?*

Yes, sole sponsor

No, multiple sponsors

Will CME be applied for this meeting?*

Yes, CPD accreditation has/ will be applied for

No, CPD accreditation is not being sought

Please upload an official request, on headed paper where possible.*

Please upload Meeting Agenda (A draft will suffice, but the final agenda will need to be provided before the meeting.):*

Email*

Phone number

IR-MEN-8-2026 Date of Preparation: February 2026