2017 Conference Grant Application

Name*
E-mail*
Conference Applying For: (choose one)*
Address*
Student Status*
School Affiliation*
Advisor/Professor*
This application has been reviewed and approved by the sponsoring professor*
Advisor Email Address*
Expected Travel Expenses*
Amounts Applied For From Other Sources
Amount Requested (USD)*
Research Paper/Talk Title*
Abstract*
How Your Work Relates to the Research or Interests of Carl Gans*
Herpetological Society Memberships
(check all that apply)
Additional Information
(if Other selected above)
Word Verification:

The "Gans Collections and Charitable Fund, Inc" expects acknowledgment for its financial contribution in any publications or other public references to the produced material.
Grant recipient agrees to permit sharing of bio, photo, and project information on the Gans Fund website, social media, and other written or electronic publication by The Fund. The Fund may be interested in publishing on its web site and other media the research papers or other outputs from the project, if available.
By submitting this form, I am also signing up myself and my advisor for the Gans Fund mailing list. I may unsubscribe at any time.

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