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WV BDC Travel Grant Application

Please note!

The BDC travel grant is for two people sharing one hotel room and is dependent on grant funding. Applying for the grant doesn't guarantee it. Please do not register for BDC until you have been notified by the chapter.

Please Note: If you are awarded the grant scholarship and do not attend BDC for any reason after your travel has been booked or you have been registered, you will be ineligible for chapter travel assistance for all future events.

1.Contact Info Person #1

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Age of Person #1

3.Please describe how Person #1 is related to the bleeding disorder community.

4.Contact Info Person #2

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

5.Age of Person #2

6.Please describe how Person #2 is related to the bleeding disorder community.

7.Have either of you attended BDC before? If yes, when?

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