Travel Grant Application
Annual Conference for Women Living with Metastatic Breast Cancer
Saturday, April 28, 2012 - Sunday April 29, 2012
Loews Philadelphia Hotel
1200 Market Street, Philadelphia, PA

   

Travel Grant applications will be accepted through Friday, April 13, 2012.

 If you are applying for only a fee waiver (no transportation assistance) please click here.

Eligibility Critera

  • Applicants with a demonstrated financial need who, otherwise, would be unable to participate in the conference.
  • Priority will be given to applicants with metastatic breast cancer.
  • Travel grants for this conference are open to people living in the United States and Canada.
  • Applicants must agree to use the funds to attend the full conference and will be required to sign in at the Travel Grant Registration table.
  • Applicants must check in showing a current, valid photo ID. Acceptable forms of photo identification include: driver's license or state issued ID card or passport.
  • All applicants must complete this application.
  • All Information provided must be accurate. Any invalid information will result in the immediate termination of your application or travel grant.
  • Applicants much complete conference evaluation forms and provide a brief testimonial statement that informs LBBC of the impact the conference had on the applicant. By applying and accepting the travel grant, recipient agrees that testimonials may be used on LBBC's website or in future marketing materials 

 

General Information

  • Completed applications should be submitted online using the form below and should be received no later than April 13, 2012 (as long as funds are available).
  • There is a maximum limit to the amount of travel grants this year:
    • $500 for continental United States and Canada residents
    • $750 for Alaska and Hawaii residents
  • All applicants must briefly describe their financial circumstances and their need for a conference travel grant.
  • The travel grant funds are provided to help cover airfare, train, bus or car transportation (gas only) and a maximum of up to two hotel nights (50% of the room rate for each night at the Loews Philadelphia Hotel); and/or the conference registration fee up to the maximum limits listed above. NO OTHER EXPENSES ARE COVERED.
  • All travel grant recipients receive an automatic registration fee wavier at the time of their approval. You do not need to fill out the fee wavier application. If you register and pay with a credit card before being approved, you will not receive reimbursement for this expense. No exceptions.
  • Travel grant funds awarded may or may not cover all expenses. Cancellation of your travel or other arrangements for any reason is not LBBC's responsiblity.
  • Travel grant recipients must reserve a room at the conference hotel, Loews Philadelphia Hotel, and share a hotel room or pay the cost difference for a single room. Cost is the same for single/double occupancy. Recipients will only be reimbursed for 50% of the room rate for a maximum of two nights. A small room block has been secured at the Loews Philadelphia Hotel at a special reduced rate of $165+tax per night [total=$190].
  • Obtaining a roommate is the responsibility of the recipient. If you are looking for a roommate, please visit the Events section of our Facebook page (just search "Living Beyond Breast Cancer" and if you haven't already, "like" us). Once there, join "Annual Conference for Women Living with Metastatic Breast Cancer" to connect with other conference attendees. Post messages there to look for a roommate. 
  • You must make your own reservations. Please reference Living Beyond Breast Cancer to obtain the reduced rate. You must make your reservation no later than April 5, 2012 to obtain the reduced rate.
  • Canadian applicants must calculate their expenses in US dollars at time ticket is purchased. All funds will be reimbursed in US dollars. Please visit this site to assist you in your conversion: http://www.xe.com/ucc/. You must list the conversion rate you used on the application.
  • Registration for the conference confirms your acceptance of the travel grant. You must register online at  http://www.lbbc.kintera.org/2012MBC or by phone at 610-645-4567 x136 within five (5) days of being notified you received a travel grant or your award will be cancelled.
  • Reimbursement of approved expenses will be made upon receipt of all travel expense receipts submitted after the conference. Expenses will not be reimbursed before the conference. All travel grant reimbursement requests must be received no later than May 25, 2012 to be processed. Reimbursement for the amount requested might not necessarily be the total amount received. Any reimbursement requests received after May 25, 2012 will not be processed.
  • Each travel grant recipient must check in at the Travel Grant Registration table at the beginning of the conference and present their current, valid photo ID. Checking in others is NOT permissible. No exceptions.
  • Applicants must complete conference evaluation forms. Evaluations will be sent electronically to your email address following the conference.
  • Note: if you are approved for a travel grant and you decide not to attend the conference, please contact Mary Susan at LBBCtravelgrants@leaddogonline.com as soon as possible so that funds can be released and available to other applicants. Not doing so may affect your eligibility for future travel grant opportunities with our organization.

Notification Process

All applicants will be notified by email or phone within 10 business days from the date the completed application was received. If you have any questions, please contact Mary Susan at
LBBCtravelgrants@leaddogonline.com .

PERSONAL INFORMATION
A separate form is required for each person requesting support.
*indicates required field
You will know you have successfully submitted your travel grant application when you see a picture of a rainbow. If this does not appear, re-check the application form and complete the sections in ALL CAPS.
FIRST NAME:* 
LAST NAME:* 
Organization (if applicable): 
ADDRESS:* 
CITY:* 
STATE or CANADIAN PROVINCE:* 
ZIP CODE:* 
EMAIL ADDRESS:* 
PLEASE RE-TYPE YOUR EMAIL ADDRESS:* 
HOME PHONE:* 
Cell phone: 
YEAR OF BIRTH:* 
Race/Ethnicity: White
 Black or African-American
 American Indian or Alaska Native
 Asian or Asian-American
 Pacific Islander
 Hispanic, Latino or Spanish origin
 Multiracial or multiethnic
DO YOU IDENTIFY YOURSELF AS A:*
(check all that apply)
 Woman who has been diagnosed with breast cancer
 Caregiver, family member, friend
 Health professional
If a caregiver, name of associated conference participant: 
Year of breast cancer diagnosis, if applicable: 
If you have had breast cancer, do you have metastatic breast cancer? Yes
 No
If you have metastatic breast cancer, please indicate your year of this diagnosis: 
If you have not had metastatic breast cancer, please briefly explain your interest in attending this conference:
EXPECTED EXPENSES
Please indicate only those expenses for which you require assistance.
I NEED FINANCIAL ASSISTANCE TO COVER MY PRIMARY TRANSPORTATION METHOD TO THE CONFERENCE:* Yes
 No
If yes, please select which form of transportation you will be using: Airplane
 Train
 Bus
 Car (gas receipts required)
If traveling by air, train or bus, please specify your hometown airport/train station/bus station. 
LBBC will reimburse no more than the actual cost for the most economical, non-refundable economy fairfare/train fare/bus fare. Please research the best method of transportation and competitive fares before applying.
INDICATE THE COST OF YOUR PRIMARY METHOD OF TRANSPORTATION REQUESTED:* 
We reserve the right to adjust your travel grant request based on reasonable roundtrip fares between your departure airport/train station/bus station and the metropolitan Philadelphia area.
COST OF HOTEL REQUESTED:* $95 (50% for one night)
 $190 (50% for two nights)
 I do not require financial assistance with hotel costs.
Canadian applicants, please indicate the conversion rate used to calculate your expenses: 
BRIEFLY (100 WORDS OR LESS) DESCRIBE YOUR FINANCIAL CIRCUMSTANCES AND NEED FOR A CONFERENCE TRAVEL GRANT. HOW WILL YOU UTILIZE THE INFORMATION YOU LEARN IN YOUR COMMUNITY?*
I VERIFY THAT ALL SUBMITTED INFORMATION IS ACCURATE AND VALID:* Yes
I UNDERSTAND THAT...
- I must agree to attend the full conference.
I must register to attend the conference within five (5) days of the date of my travel grant approval. After five days my award will be cancelled.
- If I register for the conference with a credit card before approval, I will not recieve reimbursement for this expense.
- I am responsible for making my own hotel reservations in the "Living Beyond Breast Cancer Block" room block at the Loews Philadelphia Hotel (215-627-1200). Reserve room no later than April 5, 2012 to get the reduced room rate.
- I must share a hotel room or pay the cost difference for a single room.
- I may not receive the entire travel grant amount requested based on funds available, demonstrated need or maximum limit allowed.
- I must check in at the beginning of the conference at the Travel Grant Registration table using a current, valid photo ID.
- I must submit receipts with my reimbursement form for all approved expenses to be received no later than May 25, 2012 to receive reimbursement.
- Travel grant funds will not be awarded prior to the conference for any reason. All travel grant funds will be distributed after the conference and only after receipts and supplied reimbursement forms are submitted.
- If I accepted a travel grant in the past, did not attend the conference and did not advise LBBC beforehand, I will be ineligible for future travel grants.
I HAVE READ AND ACCEPT THESE TERMS.* Yes


NOTE: If you have spam protection on your email account, please add LBBCtravelgrants@leaddogonline.com
to your address book or check your spam folder for a reply to your request.

You will know you have successfully submitted your travel grant application when you see a picture of a rainbow. If this does not appear, re-check the application form and complete the sections in ALL CAPS.

If this symbol appears at the top of the page once you submit your form, it means there has been at least one error. Please review the form, especially the required fields marked with an * to make sure that your form is complete and resubmit.