23rd National Cystic Fibrosis Family Education Conference
"Quest for Better Health: Whatever It Takes"
July 30 - August 1, 2010

To apply for a scholarship, complete and submit the form below. We will contact
you by June 15 to inform you if your scholarship (or partial scholarship) has been granted.
Note that scholarships apply to registration only, not hotel stays. Thank you.

First Name:

Last Name:
Address:
City, State, ZIP Code:

Phone Number:

E-mail Address:

Relationship to CF:

I will be arriving for the conference on:

I will be staying at Sofitel Hotel on: Thursday Friday Saturday Sunday

I would like the following meals: (Please note that CFRI pays for these meals. Do not check box if you will not be present.)
Friday Reception
Saturday Breakfast
Saturday Lunch
Vegetarian Non-Vegetarian
Saturday Buffet Dinner
Sunday Breakfast
Sunday Box Lunch
Vegetarian Box Lunch Non-Vegetarian Box Lunch

I would like to attend the following support group:

Is this your first time attending the conference?

Are you applying for Continuing Education Units (CEUs)?

How did you hear about the conference?

If you chose other, please specify:

Which CF clinic or center do you attend?

If you know, who is the CF director or coordinator there?

State why you are applying for a scholarship:

Submit

23rd National Cystic Fibrosis Family Education Conference "Quest for Better Health: Whatever It Takes" July 30 - August 1, 2010

23rd National Cystic Fibrosis Family Education Conference
"Quest for Better Health: Whatever It Takes"
July 30 - August 1, 2010