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Requestor Information

Program Details

Target Audience
Medium

**A copy of the proposed budget must be submitted with application.**

Will there be other supporters of this program?

If "yes", what percentage is Avadel being requested to sponsor:

Please upload:

  1. CME submission including needs assessment and learning objectives
  2. Detailed budget
  3. Proof of accreditation
  4. Copy of proposed agenda, if available
The above information and supporting information attached is, to the best of my knowledge, a complete and accurate description of the request for educational support from Avadel Pharmaceuticals for this activity.
Submission of this form does not guarantee approval of the request.

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