2017 CHRS Annual Meeting
EP and Cardiology Fellows Travel Grant Application

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

First Name:

Last Name:

Street Address:

City:

Province:

Postal Code:

Email Address:

Phone Number:

Institution:

Program:

Program Director /Supervisor:

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

Yes

Yes

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.