Application for the WDS International Travel Grant Program

WOMEN’S DERMATOLOGIC SOCIETY

2009 WDS International Travel Grant Program Application
Deadline for Submission is October 1, 2008

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APPLICANT INFORMATION:

Name:
E-Mail:
Address:
City:
State (if applicable):
Country:
Zip:
Telephone:
Fax:
Birthdate:	\| \|

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

List Details Here

PLEASE NOTE:
This application must be accompanied by a letter of support from your local, regional or national dermatologic society. Application deadline is October 1, 2008

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This grant program generously sponsored by: MaryKay, Inc.