Travel Grant Application - U2FP's Annual Symposium
Questions marked by * are required.
1.	First Name *
2.	Last Name *
3.	Street Address *
4.	City *
5.	State *
6.	Zip *
7.	Country *
8.	I am * Paralyzed by spinal cord injury or other condition Family Member Other
9.	Email: *
10.	Confirm Email *
11.	Airfare Expense (enter none if not flying) *
12.	If Driving, Estimated Mileage Expense (enter none if not driving) *
13.	Lodging Expense *
14.	Do you need a personal assistant in order to travel? * Yes No
15.	Personal Assistant Travel Expenses (we do not cover fees associated with caregiving as part of the travel grant award)
16.	Please indicate other sources of funding you are pursuing and/or have received to help with your expenses. *
17.	Have you received a travel grant in past years to attend U2FP's Annual Symposium (formerly, Working 2 Walk)? * Yes No
18.	If yes, how did you use your experience at U2FP's Annual Symposium (formerly, Working 2 Walk) to further your advocacy work?
19.	Please tell us about your past accomplishments and future plans as an advocate for cure. *
20.	Any Additional Comments:
21.	Telephone Number (this will be used only in the event that we need to contact you regarding travel/lodging inquiries *