Shellie Owens First-Time Attendee (SOFTA)

Travel Award Application 2025

These funds are designated for patients attending the 2025 International Research Conference & LAMposium as well as for one support person accompanying them to the conference. Patients and the support person will be responsible for paying the conference registration fee.

First Name

Last Name

Street Address

City

Mailing State/Province

Mailing Zip/Postal Code

Mailing Country (2-letter abbreviation)

Email Address

Phone Number (no dashes please)

Date of Birth (MM/DD/YY)

I am filling this application out for the following individuals:

PatientSpouse/PartnerParent/Family memberFriend

Please provide the name of partner/spouse/family member/ friend if chosen above

Patients, please provide year of diagnosis:

Estimated cost of transportation (flight or mileage) to conference, please enter numbers only:

Estimated cost of hotel (Hotel room is $234.50 per night), please enter numbers only:

Total Expected Expenses (Form will calculate)

Please determine how much of the total expenses above you are able to pay yourself and enter below, please enter numbers only:

SOFTA Travel Grant Amount Requested (Form will calculate)

Any final comments:

Contact Information