Advocacy Workshop Scholarship Application - Missouri Association of Osteopathic Physicians and Surgeons

Name

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Last

Email

Phone

Address

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Address Line 2

City

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All 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):

Advocacy Scholarship Application

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