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Please complete this form to indicate your interest in a travel scholarship to attend the 2023 ALD Connect Annual Meeting and Patient Learning Academy in person at the Houston Marriott Medical Center in Houston, Texas on November 3-4, 2023. Please note that due to limited funding we will be unable to fully fund all travel expenses. After the completion of your application, we will contact you to discuss further details. Please contact us at [email protected] with any questions.
* Your Name (First and Last)
0/50
* Email Address
0/50
* Phone number
0/50
* Home Address (where will you be traveling from?)
0/500
* Do you plan to attend the ALD Connect Annual Meeting and Patient Learning Academy in person?
* Which days of the ALD Connect Annual Meeting and Patient Learning Academy will you attend in person?
* Are you registered for the in-person ALD Connect Annual Meeting and Patient Learning Academy?
* What is your connection to the ALD community?
0/250
* For what purpose are you applying for this travel grant?
0/500
* Without the travel grant, would you be financially able to attend the ALD Connect Annual Meeting and Patient Learning Academy?
* How much money do you estimate you will need to spend to attend ALD Connect's Annual Meeting and Patient Learning Academy? Please include projected cost of plane tickets, hotel, etc.
0/500
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