Metastatic Breast Cancer Conference Stipend Application
New York Metastatic Breast Cancer Conference
October 5-6, 2019

Dear Applicants,

Thank you for your interest in attending the upcoming conference. Please read the information below before submitting your application.

A limited number of travel stipends are available to patients and friends/family or caregivers. Stipends will be issued up to $500 per family to help offset travel costs for patient and caregivers.

Stipends are awarded on a rolling basis. You will be notified of that status of your application approximately 72 hours after receipt of the application.

Stipends can be used to offset plane, bus or train fare, gas, parking and tolls, or for lodging.

If you have limited mobility and require car service to the conference, Uber/Lyft can be used within 40 miles of the conference venue. AUTHORIZATION FROM SHARE is required for the use of Uber or Lyft.

Please note:

All stipend decisions are final. There is no appeal process for decisions made regarding these awards.

All recipients must attend the conference.

Stipend recipients must submit their post- conference surveys.

Recipients are expected to make their own travel and hotel arrangements.

Receipts for reimbursement together with the reimbursement form must be submitted by October 31, 2019.

If you require a roommate, there is a closed facebook page where you can post your need for a roommate. Please note that the organizers will not be responsible for finding roommates.

The closed Facebook group can be found here: https://www.facebook.com/groups/1453447121361303/


Thank You!

Email address *
Untitled Title
First Name *
Your answer
Last Name *
Your answer
Phone *
Your answer
Email Address *
Your answer
Address 1: *
Your answer
Address 2:
Your answer
City: *
Your answer
State/Province *
Your answer
Postal Code: *
Your answer
Are You: *
Do you have metastatic breast cancer?
If yes, when were you diagnosed? *
Your answer
Are you applying for a stipend for *
Please tell us why you are in need of the stipend: *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of SHARE. Report Abuse - Terms of Service