Clinic Director

Travel Grant Application 2022

The LAM Foundation will provide reimbursement of travel costs (hotel, airfare, and/or mileage) for one member of a LAM Clinic who is in direct contact with LAM patients. We will reimburse up to $1,200 for U.S. clinics and $1,500 for international clinics. Once accepted, we will notify you with instructions for reimbursement.

First Name

Last Name

LAM Clinic Name

Position at Clinic

Clinic Street Address

Clinic City

Clinic Mailing State/Province

Clinic Mailing Zip/Postal Code

Clinic Mailing Country (2-letter abbreviation)

Email Address

Phone Number (no dashes please)

Estimated cost of transportation (flight or mileage) to conference:

Estimated cost of hotel (Hotel room is $225, per night).

Total Expected Expenses (Form will calculate)

Any final comments:

Contact Information