Academic sub-committee application 2022

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First Name

Last Name

Primary Email

Other Email

GMC Number

GMC Expiry Date

Day

Month

Year

Position

Position (other)

Specialism

What is your position within your organisation

Supporting information

This section allows you to add information in support of your application to the ABCD Academic sub-committee

What is your current role(s) and relevant experience and interests in academic diabetes

(Maximum 125 words)

What is your involvement in ABCD activities to date

(maximum 50 words, plain text)

Please tell us why you want to apply and what you feel you can contribute to the ABCD Academic sub-committee

(maximum 125 words, plain text)

Please provide the full name and of two person endorsing your application. Your endorser must be a member of ABCD.

Name of Endorser 1

Email of Endorser 1

Name of Endorser 2

Email of Endorser 2

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Address for correspondence: ABCD (Diabetes Care) Ltd, 483 Green Lanes, London, N13 4BS

Telephone: 01675 477602 Email: info@abcd.care

ABCD (Diabetes Care) is a company limited by shares in England and Wales under company number 7270377, whose registered address is Sterling House, 1 Sheepscar Court, Meanwood Road, Leeds LS7 2BB. Diabetes Care Trust (ABCD) is a registered charity number 1139057, a company limited by guarantee in England and Wales under company number 74248361,whose registered address is Sterling House, 1 Sheepscar Court, Meanwood Road, Leeds LS7 2BB. ABCD (Diabetes Care) Ltd is a wholly owned subsidiary of the Diabetes Care Trust (ABCD) Ltd

ABCD Corporate Pharma Sponsors; Gold: Astra Zeneca, Lilly, Sanofi. Silver: A.Menarini Farmaceutica Internazionale SRL,

ABCD Corporate Pump & Device Supporters, Gold: Abbott Laboratories Ltd, Dexcom, GlucoRx, Insulet International Ltd, Ypsomed Ltd; Silver: Air Liquide Healthcare Ltd, Medtrum Ltd, Menarini Diagnostics; Bronze: Roche Diabetes Care.

Read the ABCD statement on pharmaceutical industry funding

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Academic sub-committee application 2022

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