2nd National COPD Conference Travel Scholarship Submission Survey

Thanks to the generosity of several community leaders the U.S COPD Coalition is able to provide flight support to a select number of COPD patients. Please answer the following questions to be considered for this travel scholarship. For more information about the conference please visit www.copdconferencesusa.org

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1. Please tell us more about yourself:

Please tell us more about yourself: Name:
Organization:
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:

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2. The goal of the Second National COPD Conference is to provide advocacy tools to individuals with COPD and the larger COPD community. Attendees will be encouraged to return to their respective COPD communities to spread awareness and work to improve COPD policy through advocacy efforts. If you were to attend the conference how would you implement the skills and tools learned there in your community's COPD advocacy efforts? Please answer in 1-2 paragraphs.

The goal of the Second National COPD Conference is to provide advocacy tools to individuals with COPD and the larger COPD community. Attendees will be encouraged to return to their respective COPD communities to spread awareness and work to improve COPD policy through advocacy efforts. If you were to attend the conference how would you implement the skills and tools learned there in your community's COPD advocacy efforts? Please answer in 1-2 paragraphs.

3. Do you require supplemental oxygen?

Do you require supplemental oxygen? Yes

No

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3. Do you require supplemental oxygen?

2nd National COPD Conference Travel Scholarship Submission
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1. Please tell us more about yourself: