Diabetes UK Professional Conference 2020Named Lecture Application Form

The deadline for applications is 27 May 2019. To apply for the Rank Nutrition Lecture or Mary MacKinnon lecture, please use the

separate application form for that lecture.

Please email your completed form to healthcare@diabetes.org.uk. Due to the volume of high calibre applications we receive we are unable to provide

individual feedback. All successful applicants will be asked to provide review article for either Diabetic

Medicine/Practical Diabetes. More information will be provided closer to time.

Q1) Please mark an X next to the Named Lecture you would like to apply for:

Q2) Personal details

Lecture Please mark an X

Banting Memorial Lecture

Arnold Bloom Lecture

Dorothy Hodgkin Lecture

Jant Kinson Lecture

RD Lawrence

Q3) How did you hear about delivering a Named Lecture?

…………………………………………………..………………..……………………....................…………………………………………………..………………..……………………....................

Q4) Professional details

Degrees (subject, class, university and dates of study)

……………………………………………..………………………………………………..........................

……………………………………………..………………………………………………..........................

……………………………………………..………………………………………………..........................

……………………………………………..………………………………………………..........................

……………………………………………..………………………………………………..........................

Posts held (iuncluding tenure):

Personal Details

Name:

Address:

Postcode:

Phone Number:

Email:

Current occupation/position:

List of leading papaers (if applicable) NB – up to 10 only:

Q5) CitationPlease use no more than 1,000 words, including titles, to suggest why you are a suitable candidate for this lecture:

Please use no more than 100 words to provide a brief outline of your

proposed lecture.

Q6) Approver’s Details

Approver’s Details

Name:

Address:

Postcode:

Phone Number:

Email:

Current occupation/position:

Additional informationAll successful applicants will be asked to provide the slides for their presentation 36 hours before the lecture takes place. This will enable us to ensure presentation details are available on our website for delegates to download at the conference. If your presentation contains any sensitive data, please advise us accordingly and we will ensure it is removed prior to upload or replaced with a revised version with sensitive data removed.

Lecture criteriaArnold Bloom Lecture AwardIn keeping with the ideals of Arnold Bloom, this lecture is awarded to a person who is a healthcare professional working in diabetes care and has contributed significantly to improving the quality of clinical care of people with diabetes.

Banting Memorial Lecture AwardThe Banting Memorial Lecture is the highest award bestowed by Diabetes UK. The lecture is awarded to a person internationally recognised for their eminence in the field of diabetes.

Dorothy Hodgkin Lecture AwardThe lecture will be awarded to a person internationally recognised for the contribution to basic research in the field of diabetes.

Janet Kinson Lecture AwardIn keeping with the ideals of Janet Kinson, this award highlights education as an integral part of diabetes care, and is open to all health professionals, whose work in diabetes demonstrates a commitment to the delivery of education as a fundamental aspect of clinical care.

RD Lawrence Lecture AwardThe lecturer must be a professional member of Diabetes UK actively working in the field of basic or clinical science in diabetes in the British Isles at the time of his/her election to the Lectureship. The lecturer should have no more than 20 years post doctoral research experience when the lecture is delivered. Allowance will be given to applicants whose career has been subject to a late start or interruption for family or personal reasons.

DeclarationI declare that, to the best of my knowledge, all the information provided on this form

is accurate.Signed* …………………………………………………..………………………………………..............

Date ……………………………………………………..……………………………………….................

*we accept electronic signatures

Please email completed forms to: healthcare@diabetes.org.uk

Deadline: Monday 27 May 2019

Keeping in touchWe’d love to keep you updated about how we support people living with diabetes and how you can help by donating, volunteering and campaigning.

We’ll stay in touch with you by post and phone. It helps us to keep our costs down if we can email you but it’s entirely your choice. Please tick the box to tell us you are happy to receive emails

We want to send you the most relevant information so might ask you for personal data, for example about your diabetes or ethnicity. We promise to store it securely and keep it confidential. Please tick the box to tell us you are happy for us to use this information

Occasionally we may need to share personal data with our suppliers to process your orders and requests or to provide other services to us.

We promise:

Never to release your personal details to another company for their marketing purposes

To always respect your communication preferences

We only want to send you relevant information and requests to support us. To do this we may analyse the information you provide and gather extra data.

You can find out more about how we use your information at www.diabetes.org.uk/privacy

You can change how you hear from us or ask us to stop communicating with you at any time:

Visit us at https://forms.diabetes.org.uk/im-in-charge

Email us at helpline@diabetes.org.uk

Phone us on 0345 123 2399