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WDS International Travel Awards Program Application

WOMEN’S DERMATOLOGIC SOCIETY

2011 WDS International Travel Awards Program Application
Application Deadline: October 8, 2011


156K file size | 22 seconds @56k | Viewing Help

APPLICANT INFORMATION:
Name:
E-Mail:
Address:
City:
State (if applicable):
Country:
Zip:
Telephone:
Fax:
Birthdate: | |
Gender: Female .... Male
ADDITIONAL INFORMATION:
Member of AAD: Yes .... No
Member of WDS: Yes .... No
Number of AAD Meetings attended in the past five years:
Type of Practice: Private . Academic . Industry
Do you currently have funding to attend the AAD/WDS Meetings? Yes .... No
TRAVEL AWARD REQUEST DETAILS:

Reason for requesting the WDS Travel Award (E.G.)

  • Financial constraints
  • Presentation of a poster at AAD
  • Presentation of case report at "Gross and Microscopic" session
  • Professional development


PLEASE NOTE:
This application must be accompanied by a letter of support from your local, regional or national dermatologic society.



Deadline for 2011 Awards: October 8, 2011



129k file size | 20 Seconds @56k
Viewing Help

This award program generously sponsored by: MaryKay, Inc.


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