Meeting Travel Award Application - Quebec Pain Research Network

Complete this form. Information about you, your director, (co-director if applicable) will be requested in the project submission web application.

Application form

I confirm that I am a member in good standing of the Quebec Network of Junior Pain Investigators.*
- Yes
Email*
Name*
First Last
Sex assigned at birth
- Female
- Male
- I prefer not to answer
Role*
Degree in progress*
Diploma that you are preparing
Principal affiliation*
Research area*
Collaborators*
First Last Email Role Experience Afffiliation Research area
Meeting name*
For popularization videos, please indicate “YouTube”.
The congress start date*
MM slash DD slash YYYY

For popularization videos, please indicate a random date.
The congress end date*
MM slash DD slash YYYY

For popularization videos, please indicate a random date.
Congress venue*
City Country
For popularization videos, please indicate the address of your lab.
Budget requested*
Project's title*
Project type*
Project start date*
MM slash DD slash YYYY
Project end date*
MM slash DD slash YYYY
Presentation type*
Poster, Oral or popularization video.
Director’s name*
Director's email*
Authors*
Abstract*
Motivation*
Please indicate what this congress will bring you, your motivations, the specific presentations you would like to attend and the specific participants you would like to meet (max 400 words).
Budget*
Please be very precise in describing each anticipated expense (amount, quantity, taxes, currency, total). Please organize your expenses into categories (transportation, lodging, food, registration, …) (max 1000 characters)
Sans titre
- If I am selected for the Meeting Travel Award competition, I commit to display the logos of the Quebec Pain Research Network (QPRN) and the Quebec Network of Junior Pain Investigators (QNJPI) on my poster or on the acknowledgement page of my oral presentation.
Privacy policy*
I accept the Privacy policy

First	Last	Email	Role	Experience	Afffiliation	Research area