| Requesting Institution* |
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Institution Tax ID* |
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| Institution Contact* |
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Contact's Email* |
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| Institution Address* |
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Attn:
If different from Institution Contact |
| Institution City* |
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State:*
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| Institution Zip Code* |
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Mailing Preference:
Note: FedEx does not deliver to PO Boxes |
| Institution Phone* |
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Fax (xxx-xxx-xxxx) |
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| Amount requested* |
$
(numbers only) |
Total Program Budget |
$
(numbers only) |
| Type of Request* |
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Exhibit Opportunity |
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| Check this box to confirm your organization
is classified as a 501(c)(3) by the U.S. Internal Revenue Service.* |
| CME-Accredited* |
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Number of anticipated attendees:* |
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| Program Title* |
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| Geographic Region |
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| Venue #1* |
 
(click + for additional
venues/dates)
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| Event Start Date (mm/dd/yyyy)* |
|
Event End Date (if applicable) |
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| Venue #2 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
|
| Venue #3 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
|
| Venue #4 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
|
| Venue #5 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
|
| Venue #6 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
|
| Venue #7 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
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| Venue #8 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
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| Venue #9 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
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| Venue #10 |
(click + for additional
venues/dates)
|
| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
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| Venue #11 |
(click + for additional
venues/dates)
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| Event Start Date (mm/dd/yyyy) |
|
Event End Date (if applicable) |
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| Venue #12 |
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| Event Start Date (mm/dd/yyyy) |
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Event End Date (if applicable) |
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Speakers
(if known) |
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| Comments |
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| To avoid loss of submitted information, please close any open documents prior to upload. |
| Grant request letter on official institution letterhead (JPG, Word or PDF format only)*:
(PDF Help) |
(click + for additional
documentation)
Additional documentation (JPG, Word or PDF format only):
|
(click + for additional
documentation)
Additional documentation (JPG, Word or PDF format only):
|
|
Additional documentation (JPG, Word or PDF format only):
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| Completed W-9 (PDF format only)*:
(Form Help)
|
By clicking the "I Accept" button below, you acknowledge and agree to the following:
- If the grant request is approved, acceptance of funding in no way obligates the recipient to purchase, prescribe, recommend, or otherwise influence the sale of Onyx products.
- For approved program funding, the recipient must retain full control over program content and/or materials at all times. Onyx may not be involved in the selection of program topics, speakers, attendees, or otherwise influence program content. Only upon written request from the recipient may Onyx provide limited technical or logistical assistance.
- Program materials should include disclosure of grant funding (e.g., "This program is made possible through an educational grant from Onyx Pharmaceuticals, Inc."). When applicable, any significant relationship between a speaker and Onyx must be disclosed during the program as well as any discussions relating to a use that has not been approved by the US Food and Drug Administration.
- Approved funds must be used toward the above-referenced event. Unused grants, or portions thereof, shall be returned to Onyx.
- Grants will only be awarded prospectively, with sufficient lead time for review and processing. "Supplemental" grant requests to cover program overages will not be approved.
- Grants are only awarded to legitimate institutions and medical organizations, not individual parties.
- Review of requests may take up to 30 days (45 days for large/complex grants). Review decisions will be communicated via e-mail to the address entered above.
- Grant requests are reviewed on a periodic basis by a multi-disciplinary Grant Review Committee which takes into account several factors including the educational value of the program to the patient and/or medical community, independence and quality of the program sponsors, and alignment with Onyx's therapeutic areas of interest.
- Incomplete requests, including those necessitating clarification following submission, will not be processed.
- Onyx is required to maintain a copy of all approved requests for accounting and compliance reporting purposes.
If you do not accept these terms, click "I Decline" to cancel this request.
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