2023 International Member Grant Application

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* 1. Applicant Information

Full Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Please describe your reason for applying for the grant in 500 words or less:

Your reason for applying for the grant

Your personal development goals

Your plans for the future within the IAQ profession

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* 3. Did you submit an abstract for the 2023 IAQA Annual Meeting & Expo?

Yes

No

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* 4. Are you able and willing to attend the 2023 IAQA Annual Meeting & Expo, February 19-22, 2023 in Austin, TX?

Yes

No

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* 5. If you are selected, you agree to be acknowledged at the Annual Meeting, in print, and in other media including the use of photo/image as well as testimonials.

I agree with the above statement.

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* 6. Please provide us with a photo image of yourself.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Disclaimer and Signature

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* 7. By entering my name below, I certify that my answers are true and complete to the best of my knowledge.