Advocacy Scholarship Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAll applicants must update their MAOPS member profile prior to submitting their application. If assistance is needed, please contact the MAOPS Central Office at 573-634-3415. *I am a 2024 MAOPS member.My MAOPS member profile has been updated.I am available to attend all events from 9 AM - 8 PM on October 12, 2024.Why are you interested in attending this workshop? *The following are not conditions for scholarship approval. For postgraduates and practicing physicians only:I will NOT need a hotel room.I will need a hotel room on October 11, 2024.I will need a hotel room on October 12, 2024.I am willing to share a room with my colleague named below (Colleague must apply separately).Colleague name:For MAOPS Student Chapter members only:I am willing to share a hotel room with the below student(s). (Each student must apply separately).Student name(s):Submit
