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2013 Summit Travel Award
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1.
Full name of travel award applicant
(Required.)
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2.
I have a form of arthritis. Please indicate all that apply below.
(Required.)
Osteoarthritis (OA)
Rheumatoid Arthritis (RA)
Juvenile Arthritis (JA)
I have a family member with Arthritis (please specify below)
Other
If your answer was other please specify.
3.
If the nominee is under the age of 18, please list the accompanying adult. (Please note that any youth attending the Summit must be in grades K-12th)
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4.
The Arthritis Foundation is committed to serving diverse communities. We encourage racial and ethnic minorities to apply for our travel awards. Race/Ethnicity:
(Required.)
White/Caucasian
Black/African American
Hispanic/Latino
Asian American
Native Hawaiian or other Pacific Islander
American Indian or Alaska Native
Other
Prefer not to answer
If your response was other please comment.