Achondroplasia & Skeletal Dysplasia Research Conference First-Time Scholarship Request

Achondroplasia & Skeletal Dysplasia Research Conference First-Time Scholarship Request
Thanks to a generous donation, The Chandler Project is excited to offer scholarships to first-time attendees for the 6th Annual Achondroplasia & Skeletal Dysplasia Research Conference!

This scholarship is ONLY for first-time attendees. If you have attended this event in person in the past, you are not eligible to request a scholarship at this time. Those who have only ever attended virtually are eligible to apply.

FIRST-TIME SCHOLARSHIP RECIPIENTS WILL RECEIVE THE FOLLOWING:
- $250 HONORARIUM PER FAMILY/HOUSEHOLD
  - Recipients will receive the honorarium on-site at the event.
- One (1) complimentary ‘Child – ALL ACCESS’ registration
  - Child must have achondroplasia or hypochondroplasia
ELIGIBILITY & REQUIREMENTS:
- Proof of Registration: At least one member of your party must already be registered for the conference.
  - We will cross-reference this request with current registrants.
- Registration Type: Must be one of the following:
  - Parent/caregiver of a child with achondroplasia or hypochondroplasia
- Distance: Must live 100+ miles from the conference venue (Baltimore, MD).
- Statement of Purpose: Detailed request expressing reasoning for wanting to attend the conference. (See text box at the end of the form)
- Agreement to Participate: If accepted, you must be present on-site at the event.
DEADLINE TO APPLY: Sunday, May 19, by 11:00 PM ET
Yes, I have/a member of my party has already registered.
Name of member in your party if different from your own. (Please put N/A if you are the one registered)*
Name*
Email*
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
AchondroplasiaHypochondroplasiaOther
AchondroplasiaHypochondroplasiaUndiagnosedOther
Currently unbornBirth to 23 Months2 to 5 years old6 to 12 years old12 to 18 years old
Yes, they currently receive FDA-approved pharmaceutical treatment for achondroplasia.No, they do not currently receive any pharmaceutical treatment for achondroplasia.Yes, they are currently involved/enrolled in a clinical trial.No, they are not involved/enrolled in a clinical trial.
YesNoWe are currently in the decision process.We don't plan to lengthen.
Name of family member/friend if they sent you this form. (If applicable)
In complete sentences, please express your reason for wanting to attend the Achondroplasia & Skeletal Dysplasia Research Conference. What interests you about the event? What do you hope to gain from attending this event? Please be as detailed as you can.*
Should be Empty: