Travel Scholarships for 2022 Conference

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Thank you for your interest in attending our 6th Annual Team Luke Hope for Minds Pediatric Brain Injury Conference & Resource Fair. The event will be on 11/4 and 11/5 in Austin, Texas. Please fill out the form below and we will get back to you very soon to let you know if we can help!

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What is your name? *

What is your mobile number? *

What is your email? *

What is your child's name who suffered a brain injury? *

What is your child's date of birth *

YYYY

When did the injury occur? *

YYYY

Medical Information: Describe the nature of your child's injury and/or type of accident. *If you applied for financial assistance with us in the past, please write "N/A". *

Where will you be traveling from? We will only reimburse air fare if you live over 6 hours away.

List below the names of the people who plan to attend? We encourage you not to bring the whole family, if possible. Child care is limited and children can be disruptive during the presentations. If you need to bring your child(ren), please include their ages below. *

List your travel expenses below. You don’t need to include the dollar amount for you hotel or transportation to and from the conference. We will get the room for you and will be providing a shuttle from the hotel we have partnered with to the conference. Only include the number of nights you will need the room. We will reimburse you for all other travel expenses you list, if approved. You will receive a reimbursement check for the approved expenses at the end of the conference. You will need to provide receipts for all expenses. Plane tickets will only be reimbursed if you are coming from a city over 6 hours away from Austin. We can reimburse for the transportation to and from the airport. The approximate cost for that would be $25 each way. We will be paying for the hotel directly so you do not need to book the hotel yourself. We will notify you once your application has been approved with additional information and details. Here is an example of a request: Total - $500.00 (This amount will not include your hotel stay or transportation, but please list them.) Example: 1. Plane ticket - $250.00 2. Hotel – 2 nights 3. Transportation from the airport to hotel and vice versa *

Will you be able to pay for the expenses up front and we reimburse you? This is the way we prefer to handle expenses, if possible. *

Yes

Maybe

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