General Information

IMPORTANT: Members may apply for more than one bursary/ grant per year but will only be able to be the recipient of one award per year. Please submit a separate form for each application. All awards are subject to funding and applicants will be contacted prior to the Annual Conference regarding the outcome of their application.

Terms & Conditions: The names (and possibly portions of the application) of the selected winners will be published in the CANNT Journal. The nomination forms and content become the property of the CANNT Association and will only be used to promote professional nephrology excellence to its membership.

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1. Name of Applicant/Nominee:

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2. Are you a CANNT member in good standing?

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3. Name of Nominator (if not the applicant):

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4. Email

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5. Telephone #:

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6. Credentials/ Professional Designations:

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7. City/Province:

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8. Years as a CANNT member:

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9. Employer

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10. Position Held

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11. I am applying/ nominating for:

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