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ACS BIOT 2020 Travel Subsidy Application Form
This travel subsidy is for student members of the BIOT division that are presenting at the 2020 ACS Annual Meeting in Philadelphia, Pennsylvania.

Following completion of this form, a representative of ACS BIOT will contact your research advisor to request verification of financial need.

To be considered for a travel subsidy the form below must be completed before January 31, 2020.

If you have any questions, please contact peterson@acsbiot.com.
Student Name *
Your answer
Student email address *
Your answer
Name of advisor *
Your answer
Advisor email address *
Your answer
Is the student a member of ACS? *
ACS Member #
If ACS member number is not available, please forward electronic copy of ACS membership application form or confirmation email received from ACS to peterson@acsbiot.com
Your answer
Is the student a member of the BIOT Division? *
Name of School *
Your answer
Department *
Your answer
Presentation Title *
Your answer
Preferred Presentation format *
Name of the Session for which the abstract was submitted for
For oral presentations only
Your answer
Preferred Mode of Payment
Mailing address for Travel Award Check
Please provide accurately the address where the Travel Award Check should be mailed to (if the Travel Subsidy is granted).
Your answer
Pay-to-the order of
Please provide accurately in whose name the Travel Award Check should be written for (if the Travel Subsidy is granted).
Your answer
Paypal Account Information
Your answer
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