Application for Trainee Travel Awards for the 26th Annual Conference of the American Society for Reproductive Immunology

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Application for Trainee Travel Awards

Any student or trainee who will be attending our annual meeting can apply for financial support to off-set or pay for their travel costs. To be considered for a Trainee Travel Award, please register for the meeting, then complete and submit the application below AND e-mail (joanne.kwak-kim@rosalindfranklin.edu), fax (847-247-6951) or mail (ASRI; 830 West End Court; Suite #400; Vernon Hills, IL 60061) your curriculum vita to Joanne Kwak-Kim, MD, President, ASRI.

If you experience problems submitting your application or have questions, please see our assistance section.

Step 1

Complete and submit the information below.

First Name:

Last Name:

Institution:

Address:

City:

State:

Zip:

Country:

Phone:

Fax:

E-mail:

Level of Training:
(select one)

	Graduate Student
	Medical Resident/Fellow
	Post Doctoral Fellow

Number of past ASRI annual meetings attending:

Are travel funds available to you thru a grant or your institution?
(select one)

	Yes
	No

Have you submitted or will you submit an abstract to the 28th Annual Meeting?
(select one)

Note: abstract submission is NOT required to receive the trainee travel award.

	Yes
	No

I certify that the above information is true to the best of my knowledge:
(please initial)

Name of Supervisor or Department Head:
(this person will be asked to verify information submitted)

Phone of Supervisor or Department Head:

Fax of Supervisor or Department Head:

E-mail of Supervisor or Department Head:

Describe your 1) research and 2) career plans:
(300 word limit)

Step 2

Assistance

Technical problems submitting your application?
E-mail: webmaster@theasri.org

Questions about the trainee travels awards?
E-mail: Joanne Kwak-Kim, MD, ASRI President

HELP! I can't submit my application!
If you have trouble submitting your application online, e-mail the above information as a Word or WordPerfect file to our webmaster.

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