2017 CHRS Annual Meeting
Basic Science Researchers Travel Grant Application

September 15-16, 2017
The Westin Nova Scotian, Halifax, NS

Limited funds are available for supplementation of the costs of travel/accommodation for Basic Science Researchers wishing to attend the 2017 CHRS Annual Meeting. Criteria for eligibility for such funds are that the researcher be:
1) engaged in heart rhythm/arrhythmia research;
2) looking to forge or solidify collaborations with clinical partners in the area of arrhythmia research; and
3) prepared to be consulted on or engaged in discussions that seek to define how basic science should be integrated into the 2018 CHRS Annual Meeting.

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* 1. Please complete the following information:

First Name:

Last Name:

Street Address:

City:

Province:

Postal Code:

Email Address:

Phone Number:

Institution:

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* 2. Provide a brief description of your heart rhythm/arrhythmia research:

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* 3. Describe your main motivation for attending the 2017 CHRS Annual Meeting:

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* 4. Mode of transportation to the meeting:

I will be flying to the meeting

I will be taking the train to the meeting

I will be taking the bus to the meeting

I will be driving to the meeting

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* 5. Are you a member of the CHRS?

Yes

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* 6. Are you receiving any other source of funding to attend the meeting?

Yes

Uncertain at this time

If 'Yes' or 'Uncertain' please specify:

Proof of travel to and from the meeting will be required to receive the funds.