Travel Assistance Form
Financial assistance for the 2021 Pediatric Summit in Phoenix, AZ is available to pediatric melanoma patients and their immediate family members only.

(NEW as of July 28, 2021) Applications received after July 28, 2021 will be entered into a random lottery to determine who will receive reimbursement. Registration for the Summit must be made prior to applying for assistance. Applications must be received by Monday, August 23rd, and recipients will be notified by Friday, August 27th.

The following costs associated with your travel to the 2021 Pediatric Melanoma Summit will be reimbursed to you 3-4 weeks after the event. Only one option (flight or driving) will be reimbursed. All travel arrangements must be made on your own.

Flight Reimbursement: A maximum of $300 per family toward your flight(s) will be reimbursed.

Driving/Mileage Reimbursement: If driving to the event, mileage for one vehicle per family will be reimbursed at $0.54/mile, not to exceed $300 total. To calculate mileage, the address provided below will serve as the “start” address and the Great Wolf Lodge in Phoenix will serve as the “end” address. A Google/Mapquest map showing exact mileage must also be provided.

        Great Wolf Lodge
        7333 N. Pima Road, Scottsdale AZ
        85258, USA

If your plans change, you cancel your travel arrangements or you do not attend, you will not be reimbursed.  

All receipts (and map, if driving) must be emailed to the Programs Team at education@melanoma.org by September 24, 2021.
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NAME (First and Last) *
Address (Street,City, State, Zip) *
Phone *
Email Address *
I/We plan on: *
I have read and understand the flight/driving reimbursement guidelines and instructions. (Typed name & date may serve as your electronic signature.)
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