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* 1. Have you been a member-in-good-standing of CAGP for at 3 months before the application deadline (February 4, 2019)?

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* 2. With the exception of the two bursaries available to individuals from the Quebec City area, bursaries are only available to CAGP members. Do you reside or work in the Québec City/surrounding area?

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* 3. First Name

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* 4. Last Name

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* 5. Job Title

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* 6. Organization/Company

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* 7. City

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* 8. Province

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* 9. Telephone

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* 10. Email

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* 11. What CAGP local Chapter are you affiliated with? (N/A for Québec City area applicants)

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