2019 National Conference Travel Scholarship
First Name
Last Name
Birthdate MM/DD/YYYY
Personal email
Mobile Phone
Mode of Transportation
Please select...
Airplane
Bus
Train
Car
Other
No transportation needed
Departing city and requested travel scholarship amount
Would you like overnight accommodations with our group?
Wednesday night, 6/19
Thursday night, 6/20
Friday night, 6/21
No accommodations needed
Overnight accommodations will be at the Leadership Institute dorms, a short walk to the Clarendon metro station. The conference will be a short walk from the Union Station metro station. Check in will be Wednesday afternoon or Thursday between 8 and 10am. Check out will be Saturday morning. Times and final details will be shared in advance of conference.
Name and address where you would like the travel scholarship reimbursement check sent.
I understand that the travel scholarship will be in the form of a reimbursement check that will be mailed to me after I attend the conference.
Check here.
Please attach your completed
GENERAL AND MEDICAL LIABILITY RELEASE
.
Please attach your completed
CODE OF CONDUCT
.
Submission of this form is not a formal offer of scholarship or accommodations. Please check your email for an email with your application status.
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