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* 1. Please complete the following information:

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* 2. Which category best describes you?

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* 3. Please complete the following information:

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* 4. Please provide a brief description of your heart rhythm/arrhythmia research:

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* 5. Are you receiving any other source of funding to attend the CCC?

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* 6. Please upload an abbreviated copy of your curriculum vitae (maximum two pages).

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* 7. Please upload a copy of your Letter of Confirmation to present an accepted abstract at CCC.

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* 8. By checking the box below, I am giving my digital signature and verify that the information I have submitted on this form is true and accurate:

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* 9. Date of signature: 

Date
Click the the SUBMIT button below to finalize your travel grant application.

Questions? Contact chrs@ccs.ca

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