Exit this survey 2nd National COPD Conference Travel Scholarship Submission 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 Question Title * 1. Please tell us more about yourself: Name: * Organization: Address: * Address 2: * City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: * Email Address: * Question Title * 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. Question Title * 3. Do you require supplemental oxygen? Yes No Done