Exit 2019 IGCS Survivor-Caregiver Symposium“YES” to Empowerment & SurvivorshipTravel Grant ApplicationWindsor Convention & Expo Center Rio de Janeiro, Brazil Saturday, September 21, 2019 Please complete all questions/sections to apply for a need-based Travel Grant to assist you in attending the Symposium. If a question does not apply to you, please type “Not Applicable.” Incomplete applications will not be considered for award. If you have questions about the Symposium or the Travel Grant program, please contact Dicey Scroggins at dicey.scroggins@igcs.org.Applications must be submitted by August 23, 2019, at 11:59 pm EST. We will not review applications received after August 23. Question Title Please enter your contact information. First Name Last Name Street Address City/Town State/Province ZIP/Postal Code Country Email Address Phone Number (with country code) Question Title Are you a cancer survivor? Yes No If yes, please enter the type of cancer: Question Title Are you a family member or caregiver of a cancer survivor? Yes No If yes, give your relationship: Please list all advocacy organizations in which you are active, give your position (if applicable) and provide the website address. Question Title Advocacy Organization Organization Your Position (if applicable) Website Address Question Title Advocacy Organization Organization Your Position (if applicable) Website Address Question Title Advocacy Organization Organization Your Position (if applicable) Website Address Question Title How did you hear about the Symposium? Question Title In a short statement (no more than 150 words), please tell us why you want to attend the Symposium. What do you hope to contribute, gain and share? Question Title In a short statement (no more than 150 words), please tell us why and for what you need financial support to attend the Symposium, including the approximate amount in US dollars. Question Title Please provide any other information that might assist us in reviewing your application (in no more than 100 words). Please submit your application as soon as possible. We will make award decisions as applications are received. Thank you for your interest in this very special Symposium and for your application. Submit Application
