Conference/Membership Waiver Application Form

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  You are required to LOG IN to access the Conference/Membership Waiver Application Form. If you do not have a user account you may CREATE one. *NOTE: You will be required to validate your account request by clicking the log in link in the "Account details" email you will receive when you register.

If you would like to be considered for this award, please fill out the following application form by December 1 December 15. Consideration will be given based on the order in which applications are received.

 Please note that individuals who have received awards or waivers in the past three years are still eligible for registration waivers.

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* indicates required field

  • Name *
  • Address *
  • Email address *
  • Other means of contact (phone or other)
  • Institutional or Professional affiliation *
    Enter "n/a" if this does not apply to you.
  • Abstract Title or Brief Description of Conference Contribution *
  • Please describe why you want to participate, how you will contribute to the conference meetings, and what impact you think it will have on yourself and your community? *
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