BioXPhi Funding Question Title * 1. Contact Info Name Institutional Affiliation Email Address Phone Number Question Title * 2. Travel Arrangements for which you intend to seek reimbursement (check all that apply) Train Car Service/Uber Personal Vehicle Public Transit Plane Other (please specify) Question Title * 3. Place of Departure (i.e., airport, train station, etc.) Question Title * 4. Date of Arrival in Yale/New Haven Date / Time Date Question Title * 5. Date of Departure in Yale/New Haven Date / Time Date Question Title * 6. Check all forms of acceptable accommodations Hotel AirBnB Friend/Acquaintance Personal Lodgings N/A (I'm not staying overnight) Other (please specify) Question Title * 7. Would you like to be considered for Funding? Yes No Other (please specify) Question Title * 8. Will you be applying for Funding from your home institution? Yes No Other (please specify) Question Title * 9. If you answered "YES" to the previous question, how much funding do you expect to receive? All of my travel and accommodation costs will be covered in full Only my travel expenses will be covered in full Only my accommodation costs will be covered in full Some of my travel expenses will be covered Some of my accommodation costs will be covered None of my travel or accommodation costs will be covered I don't know Other (please specify) Question Title * 10. If you answered "YES" to the previous question, and you have a specific budget allotted for your expenses and are still seeking funding from the BioXPhi Conference Organizers, please indicate the amount you expect to receive from your home institution. Done