THE MOLLY TOWELL PERINATAL RESEARCH FOUNDATION

Document Sample
THE MOLLY TOWELL PERINATAL RESEARCH FOUNDATION Powered By Docstoc
					                                                    780 Echo Drive
                                                    Ottawa, Ontario
                                                          K1S 5R7
________________________________________________________________



               CONFERENCE SUPPORT APPLICATION FORM

Normally, the limit for applications is $6,000 for general conference support in addition to
$2,500 for a named Molly Towell Lectureship. Please see information regarding Areas of
Funding and Evaluation of Application at www.apog.ca/mtprf. Applications must be submitted
by October 15, 2010. Applications will not be considered after the conference.



Name of Applicant:                              Total Amount Requested:




Title of Conference:




Complete Mailing Address:                       Contact Information:

                                                Telephone: ____________________________

                                                Fax:       ____________________________

                                                E-mail:    ____________________________



Host Institution:

Is host institution providing matching funds?           Yes      No

On a separate page, please provide other sources and amounts of proposed/confirmed support.




                                           Page 1
                                                    780 Echo Drive
                                                    Ottawa, Ontario
                                                          K1S 5R7
________________________________________________________________


In the following space, please indicate the purpose of the conference and note how it
will fulfill the intentions of the Foundation.




Conference Program:

Please append a current proposed program for the conference.




                                        Page 2

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:6
posted:10/1/2012
language:Unknown
pages:2