RedHill Biopharma - Our Programs - Medical Grant & Investigator Initiated Study Requests

Organization Name *

Organization Name is required

Tax ID *

Tax ID is required

Organization Address *

Organization Address is required

Organization City *

Organization City is required

Organization State *

Organization State is required

Organization Zip Code *

Organization Zip Code is required

Representative Name *

Representative Name is required

Email *

Email Address is required

Phone *

Phone Number is required

Program Name *

Program Name is required

Location/Venue *

Location/Venue is required

Date *

Date is required

Program Address *

Program Address is required

Program City *

Program City is required

Program State *

Program State is required

Program Zip Code *

Program Zip Code is required

Amount ($) Requested *

Amount Requested is required

Total Program Budget *

Total Program Budget is required

Select the type of funds for which you are applying. *

Charitable Contribution

Sponsorship

Education Grant

Select the type of funds for which you are applying is required

If funded, how would you like to receive your funding? *

One Payment

Multiple Payments Throughout the Year

If funded, how would you like to receive your funding is required

Instructions for Payment Processing (Include name, address and any special instructions) *

Instructions for Payment Processing (Include name, address and any special instructions) is required

Is the program accredited by an independent, recognized accrediting body or are you seeking accreditation from such a body (e.g., ACCME, CEU, ACPE)? *

Yes

No

Is the program accredited by an independent, recognized accrediting body or are you seeking accreditation from such a body (e.g., ACCME, CEU, ACPE) is required

Does the program/activity have a bona fide educational or scientific purpose? *

Yes

No

Does the program/activity have a bona fide educational or scientific purpose is required

How many years has this event/program been in existence? *

How many years has this event/program been in existence is required

Describe the program/activity and its purpose, including the healthcare topic or disease state to be discussed. *

Describe the program/activity and its purpose, including the healthcare topic or disease state to be discussed is required

Describe the sponsorship benefits being offered, if any. *

Describe the sponsorship benefits being offered, if any is required

Are other pharmaceutical companies also being solicited for the same or similar levels of sponsorship? *

Yes

No

Are other pharmaceutical companies also being solicited for the same or similar levels of sponsorship is required

Is the event broadly advertised (e.g., is the program intended for an audience that goes beyond a single practice or institution)? *

Yes

No

Is the event broadly advertised (e.g., is the program intended for an audience that goes beyond a single practice or institution) is required

Composition: *

Local

Regional

National

International

Composition is required

Target number of attendees: *

Target number of attendees is required

Other relevant information:

Will RedHill funding be used for transfers of value to healthcare providers (this includes meals, or speaker/facilitator payments)? *

Yes

No

Will RedHill funding be used for transfers of value to healthcare providers (this includes meals, or speaker/facilitator payments) is required

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Terms *

Consent is required

Medical Grant/Sponsorship

Organization Information

Contact

U.S. Commercial Office

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25-50
50-100
100-150
150-200
200-300
300-500
500-1,000
1,000-2,000
2,000-3,000
more than 3,000