Paediatric Group Associate Member
Travel Bursary Application Form
APPLICATION DEADLINE: APRIL 30, 2015
The intent of the Travel Award is to help facilitate the attendance of Allied Health Professionals at
the Annual CST Paediatric Special Interest Group Annual Dinner and Business Meeting. The award
is intended for individuals whom do not have accessible funding and who are Associate Members
of the CST and the Paediatric Special Interest Group. The award is $500 per recipient and there can
be up to 5 awardees per year. Award recipients are required to attend the CST Paediatric Group
Annual Dinner and Business Meeting.
Application Form
(Please Print)
LAST NAME
FIRST NAME
INSTITUTION
OCCUPATION:
Nurse
Coordinator
Pharmacist
Social Worker
OT / PT
Other
_________________
ADDRESS
CITY/PROV
POSTAL CODE
EMAIL
TEL
FAX
NOTE: THERE IS NO CHARGE TO ATTEND THE CST PAEDIATRIC GROUP
ANNUAL DINNER AND BUSINESS MEETING. PLEASE NOTE THERE ARE A
LIMITED NUMBER OF TRAVEL AWARDS. PRIORITY WILL BE GIVEN TO THOSE
WHO HAVE NOT RECEIVED THE BURSARY IN THE LAST 5 YEARS AND WHO
DO NOT HAVE OTHER FUNDING TO ACCESS THE CST.
YES
I HAVE ACCESS TO FUNDING TO ATTEND CST
PLEASE SEND THE COMPLETED FORM TO THE CST OFFICE:
CANADIAN SOCIETY OF TRANSPLANTATION
114 Cheyenne Way, Ottawa, ON K2J 0E9
Phone : 877.068-9449 | FAX : 613.491-0073
E-mail: admin@cst-transplant.ca | www.cst-transplant.ca
NO