Travel Assistance Application Form

Your Name (Required)   APS Member Number
Gender   Female     Male
School or Affiliation (Required)
Address (Required)
City (Required)   State   Postal Code/Zip Code
Province   Country
Telephone   Fax
Email Address (Required)
Student Status   Graduate     Undergraduate
Volunteers are provided with t-shirts to wear during their volunteer shift. Please select your preferred t-shirt size.
Small Medium Large XL XXL
Have you made a submission to the convention ( e.g. poster or symposium)? (Required Field)  
Number of Submission(s)  
Type of Submission(s)   Poster     Symposium
Submission Information
Please provide the Title, author(s), and 50-word abstract for each submission.
Separate each submission with a blank line.
Please use the following area to establish need for Travel Assistance.
Have you sought funding from your Institution?
How much funding is your university offering for conferences/travel/etc.?
Please give an itemized list of the funding you will need for this conference. Only valid expenses will be considered ( i.e. transportation). Separate each item with a blank line.
Indicate the dates you plan to attend the conference.
Thursday, May 23
Friday, May 24
Saturday, May 25
Sunday, May 26
Have you ever received an APS Travel Award before?"
Yes No
Have you ever been involved in any APSSC programs or events?
Yes No
If yes, please describe briefly:

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