Limited funds are available to help students and
young scientists in attending the 1998 Annual Meeting by
contributing toward travel and related costs.
Preference will be given to those presenting a paper. To apply for
assistance, send this completed form,
a copy of the submitted abstract and certification of student status by
March 6, 1998
to:
| Student Travel Grant Fund American Crystallographic Association P.O. Box 96, Ellicott Station Buffalo, N.Y. 14205-0096 |
If using overnight mail send to: American Crystallographic Association c/o Hauptman-Woodward Medical Research Inst. 73 High St., Buffalo, N.Y. 14203 |
| Family Name ________________________________ | First Name __________________________________ |
| Dept _______________________________________ | Inst_________________________________________ |
| Street ______________________________________ | Box/Apt#____________________________________ |
| City _______________________________________ | St/ Prov __________Zip/PostalCode______________ |
| Country ____________________________________ | Phone ______________________________________ |
| Fax ________________________________________ |
Title of Paper: ____________________________________________________________________________ ________________________________________________________________________________________ |
Estimated cost of travel (provide full details): ____________________________________________________ ________________________________________________________________________________________ |
Estimated cost of meals and lodging (provide full details): _________________________________________ ________________________________________________________________________________________ |
Endosement of Research Director: ____________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ |
| Total amount requested:_______________________ |
| Have you ever applied for an ACA travel assistance grant? ____No ____ Yes, in 19__ |
| Have you ever received a travel assistance grant? ____No ____ Yes, in 19__ |
| Are you an ACA member? ____No ____ Yes |
ATTACH A COPY OF YOUR ABSTRACT TO THIS APPLICATION FORM
Signature of Applicant: ___________________________________ Date: ___________________