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Travel Assistance Form
[Please note: if you applied for assistance for the September Summit, you MUST resubmit to be considered for January]

Financial assistance for the January 2022 Pediatric Summit in Phoenix, AZ is available to pediatric melanoma patients and their immediate family members only.

To ensure fairness, applications will be entered into a random lottery to determine who will receive reimbursement. Registration for the Summit must be made prior to applying for assistance. Applications must be received by Friday, January 7, 2022, and recipients will be notified by Friday, January 14, 2022.

Should you be selected, the following costs associated with your travel to the January 2022 Pediatric Melanoma Summit will be reimbursed to you 3-4 weeks after the event. Only one option (flight or driving) will be reimbursed. All travel arrangements must be made on your own.

Flight Reimbursement: A maximum of $1000 per family toward your flight(s) will be reimbursed.

Driving/Mileage Reimbursement: If driving to the event, mileage for one vehicle per family will be reimbursed at $0.54/mile, not to exceed $1000 total. To calculate mileage, the address provided below will serve as the “start” address and the Great Wolf Lodge in Phoenix will serve as the “end” address. A Google/Mapquest map showing exact mileage must also be provided.

        Great Wolf Lodge
        7333 N. Pima Road,
        Scottsdale AZ 85258

If your plans change, you cancel your travel arrangements or you do not attend, you will not be reimbursed.  

All receipts (and map, if driving) must be emailed to the Programs Team at education@melanoma.org.
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Patient Name (First and Last) *
Address (City, State, Zip) *
Phone *
Email Address *
We plan on: *
Parent or Guardian: I have read and understand the flight/driving reimbursement guidelines and instructions. (Typed name & date may serve as your electronic signature.)
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