CHAMP1 Family & Science Conference

Travel Grants

Provide details below to apply for a travel grant to attend the
CHAMP1 Family & Science Conference in Rimini, Italy

Please note that funds for the travel grant are limited, and each application will be
assessed on a case-by-case basis by the CHAMP1 Research Foundation board.

Those applying for grants will be expected to attend all 3 days of the conference
and along with their CHAMP participate in blood draws, data collection & clinical evaluations.

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Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number

Will Others Be Attending With You?

Name of CHAMP

First

Last

Would you be willing to fundraise to help raise money?

I agree that me and my CHAMP will participate in research at the conference

e.g. Blood Draw, Data Collection, Clinical Evaluation

I intend to attend all 3 days of the conference

How much money would you need to make it to the conference?

Please, in a paragraph or two, explain your financial situation and why you need this grant to make it to the conference. Include any additional information.

Phone

CHAMP1 Family & Science Conference

Travel Grants

Provide details below to apply for a travel grant to attend theCHAMP1 Family & Science Conference in Rimini, Italy

Provide details below to apply for a travel grant to attend the
CHAMP1 Family & Science Conference in Rimini, Italy