AHRMM22 UDI Forum Scholarship Application AHRMM is pleased to offer financial assistance for qualifying members to attend the UDI Forum, powered by the AHRMM LUC, November 1-3, 2022. Registration Scholarship – The scholarship covers full registration to the UDI Forum. To qualify, you must meet the requirements listed here and complete this application. Applications are due on October 14, 2022. All applicants will be notified of results by October 21, 2022.To apply for the scholarship:1. Complete the online application.2. Submit a letter from your CEO or supervisor that establishes financial with application. If you are between jobs, only the application is required. To become an AHRMM member, visit www.ahrmm.org/join or call us at 312-422-3840. Question Title * Contact Information Name * Company * Address Address 2 City/Town * State/Province -- 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/Postal Code Country Email Address * Phone Number * Question Title * AHRMM Membership Number Question Title * Are you a new member? Yes No Question Title * Have you attended and AHRMM Conference & Exhibition in the past? Yes No Question Title * Are you an AHRMM chapter member? Yes No Chapter name (if applicable): Question Title * Do you have your CMRP designation? Yes No Question Title * Are you an AHRMM Fellow? Yes No Question Title * Why do you require financial assistance to attend the AHRMM UDI Forum? Question Title * What do you want to gain from attending the AHRMM UDI Forum? Question Title * How will you share what you learn at the AHRMM UDI Forum with your colleagues? Question Title * A support letter from your CEO or supervisor that establishes financial need can be uploaded here or emailed to ahrmm@aha.org after your application submission. Please include your name and member ID. PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File A support letter from your CEO or supervisor that establishes financial need can be uploaded here or emailed to ahrmm@aha.org after your application submission. Please include your name and member ID. Done