Each recipient of the travel grant is awarded a COMPLIMENTARY REGISTRATION TO THE ISPOR EVENT inclusive of SHORT COURSES (up to 4 courses) – registration to be submitted to ISPOR for processing prior to the Meeting/Congress/Conference. Also inclusive is up to $1,800 for round trip coach/economy class travel, hotel, meals, and conveyance expenses. Recipients will be responsible for booking their own hotel and flight. ISPOR will not release funds prior to the event to cover these expenses. Reimbursement form, including all required receipts, must be submitted within 30 days after event ends. Note: All non-US $ reimbursements will be made via bank transfer.
*required information
ISPOR MEETING TRAVEL GRANT APPLICATION
* Select ISPOR event you want to apply for  

You must be an ISPOR member to be eligible for Travel Grant

*Are you an ISPOR member?      
If yes, please indicate your ISPOR Member ID # (Membership verified)
*First Name:      *Last Name:   
*Professional affiliation (place of work):  
*Primary Address:  
 Address 2:
*City:   
  State:   *Zip:     
*Country:  
*Phone:    Fax:  
*Email:    
*Have you received an ISPOR travel grant to a previous ISPOR Meeting/Congress/Conference?
 
If yes, which meeting (including the year):
*Are you a member of an ISPOR Chapter?   
If yes, which chapter:
Please describe your role/contribution to the Chapter’s activities (up to 100 words):
*Statement of Intent/Proposal: How will attending the ISPOR event you have selected assist you in development/use of HEOR in health care decisions in your country/region? (up to 250 words; the proposal should include relevant aspects of the applicant’s professional and academic background):
 
*Brief description demonstrating the need for financial support to attend an ISPOR meeting that is not available by any other means (up to 100 words):
 
*Have you submitted an abstract for selected ISPOR event?     
If yes, has your abstract been accepted?  
*Are you scheduled to make a presentation at the ISPOR meeting (ie, ISPOR Regional group committee/SIG/WG meeting, Forum)?     
Comments:

I understand that the grant includes complimentary registration to the ISPOR event including up to 4 short courses and up to $1,800 USD in travel/accommodation expenses that will be reimbursed after the ISPOR event as per the ISPOR Travel and Reimbursement Policy. Expenses exceeding this amount and/or failing to comply with the above mentioned policy will be my responsibility. Upon being selected to receive the grant, I agree to submit the reimbursement form including all required receipts within 30 days after the last day of the ISPOR event.

*Signature (typing your name is your signature)    
 

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