AAG Annual Meeting Enrichment Funds Application Form
Who is submitting this request?
First name *
Your answer
Last name *
Your answer
Affiliation *
Your answer
Phone Number *
Your answer
Email address *
Your answer
Who is the proposed participant?
Is the proposed participant a student? *
Note, students are not eligible to apply for Enrichment Funds
First name *
Your answer
Middle name
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Last name *
Your answer
Address *
Your answer
Affiliation *
Your answer
City *
Your answer
State *
Your answer
Country *
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Postal Code *
Your answer
Phone Number *
Your answer
Email address *
Your answer
Disclosures
Disclosures A: residence status of the proposed participant *
Disclosures B: relationships of the proposed participant *
Required
If you checked any of the boxes above, please explain below. *
If you checked None of the above, please write NONE
Your answer
Funding Request
Funding request A. *
Funding request B
Please indicate the total amount of additional funds below, if you are requesting more than the registration fee
Your answer
Funding request C.
Please justify any additional funds requested.
Your answer
Supplementary Information
Supplementary information A. *
How will the the guest participate in the AAG Meeting? Include presentation title and session titles if known.
Your answer
Supplementary information B. *
How will the presentation enrich the AAG Annual Meeting?
Your answer
Supplementary information C. *
Which individuals or groups are sponsoring the guest's participation in the meeting? Please elaborate if the guest is part of a special event. If listing Specialty Groups, please spell out the full name.
Your answer
Supplementary information D. *
What is the dollar amount of the external sponsorship mentioned above? Please indicate NONE, if there is no outside funding.
Your answer
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