Up to 10  applicants who reside in lower-middle and lower income countries as defined by World Bank Classifications will receive complimentary registration to the 2020 AMP Virtual Annual Meeting and Expo. Preference will be given to AMP members.

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* 1. Name

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* 2. E-mail Address

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* 3. Current Position

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* 4. Employer/Institution

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* 5. City, State, Country

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* 6. Primary Degree (Please select one)

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* 7. Primary workplace setting (Please select one)

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* 8. I certify that I am currently an AMP Member.
NOTE: To renew your membership or to become a member, please go here.

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* 9. My AMP Member ID Number Is

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* 10. Please provide a brief (< 100 word) statement of need for aid to attend the virtual AMP Annual Meeting and Expo

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* 11. How will attending the Virtual AMP Annual Meeting and Expo benefit your professional development and/or career? [250 word limit]

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* 12. Gender (Optional; choose one)

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* 13. Race/Ethnicity (Optional; choose one)

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* 14. In what year were you born? (Optional; enter 4-digit birth year; for example, 1976)

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