2022 International Congress on Palliative Care

Part 1 - Tell Us About Yourself

Submitter/Contact Person

First Name:

Last Name:

Email:

Confirm Email Address:

Phone Number:

Presenter

First Name:

Last Name:

Email:

Confirm Email Address:

Phone Number:

Organization Name

Organization Website:

Country:

Occupation Title

Short Bio (100 words)

Part 2 - Describe the Innovation

In 250 words or less, explain:

What was the need?
What inspired the solution?
How did you develop the innovation?
What “impact story” illustrates the results?

Innovation Title

Innovation Description

Part 3 - Take the 30 second challenge

Summarize your innovation in a 30 second audio or video file or in 75 words.

I will upload
Audio/Video
file after signing up

Part 4 – Share your plans for the prize

Explain how you intend use the money to further the mission of your innovation. (75 words)

If selected as a finalist, I agree that the Canadian Virtual Hospice and the International Congress on Palliative Care can use my name and presentation in promotional activities, videotape my presentation, post my presentation on their website and livestream my presentation.