Please Return the Completed Form to the Education Team by Email

British Institute of Radiology

Application for external educational event approval

Applicant Details

Organisation:

Contact Person: Title First name Last name Job Title: Address for correspondence:

Tel: Email: Invoice details (if different from above): Name and address for Invoice:

Email:

Type of organisation: NHS Organisation University or College Not for profit organisation Commercial organisation Other (Please specify):

Is your organisation a BIR Yes No

______BIR application for external educational event approval 1 Corporate member?

Is your organisation a Yes No registered charity? If Yes, please state your charity number:

Please state the nature of your organisation’s business and experience of delivering educational events

Meeting / Event Information

Title of event

Topic area, specialty, modality e.g. cardiovascular imaging/ management / radiation protection/ brachytherapy etc.

Proposed date

Proposed length

Proposed location

Expected size of the audience

Target audience Please list all professional disciplines and levels

Content and Delivery

Educational aims What are the overall aims of this event and how do these contribute to / are relevant to the fields of radiology, radiation oncology or the underlying sciences?

Learning outcomes 1. These help participants and employers to identify what they can expect to 2. gain from this event and its contribution to the participant’s 3.

______BIR application for external educational event approval 2 professional development. At least TWO learning outcomes 4. MUST be completed.

Do these learning outcomes match to any professions formal training curricula? If yes please specify Delivery methods How will the educational content be delivered e.g. lectures, debate, on- line, workshop? Lecturer / Facilitator details Speaker names, titles and places of work; scope of practice, any specialisms, relevant professional experience (Copy of CV can be attached if this is available) Pre or post event learning Are there any opportunities for pre or post event learning using on-line material/reading lists/CPD links/quizzes etc.? If yes, please give details. Feedback and evaluation Identify how delegate feedback will be obtained and used to evaluate effectiveness of the event. Please attach a copy of the feedback form. Marketing / Promotion

Is this a joint meeting? Yes No

If yes - with which society(ies)/organisation(s)

Approval / Accreditation Have you applied for / or will be applying for approval or accreditation from other organisations – if yes please provide details.

Short summary of event Short paragraph for event announcements/marketing – 3approx. 200 words and to include key words/phrases. If event is approved this would be used on BIR website to promote the event. ______BIR application for external educational event approval 3 Attachments Please attach copies of the following documents Programme to include:  Timings  Provisional lecture / session titles  Speaker names, titles and places of work;  Any panel discussion/chairperson  Any other activities – workstations, posters etc. Pre or post learning materials Promotional materials

Additional comments

Please return the completed form to the Education Team by email: [email protected] If you have any questions please e-mail the Head of Education: [email protected]

______BIR application for external educational event approval 4