2025 Annual Symposium - Scholarship Request Form

2025 Annual Symposium Scholarship Request Form
The International Consumer Product Health and Safety Organization (ICPHSO) will hold its 2025 Annual Meeting & Training Symposium on February 17 - 20, 2025 in Orlando, Florida. If you would like to be considered for a scholarship to help cover the costs of registration, hotel and/or travel, please fill out the form below.
Applicant Information
Name*

First NameLast Name
Organization*
Position/Job Title*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
Why do you feel it is important to attend?*
Do you have a Product Safety/Injury Prevention Program?*

YesNo
Are you a member of ICPHSO?*

YesNo
Have you funded yourself at any past ICPHSO meetings?*

YesNo
When was the last time you attended an ICPHSO meeting?*
Please enter the amount of support requested per category. If $0 is needed in a category, enter $0.
Registration- Mbr: $1100, NM: $1600 ($USD)
Flight / Train ($USD)
Hotel Room ($USD)
Meals- Session Days Only - if not already provided ($USD)
Other- Parking, Taxi... etc. ($USD)
Enter the TOTAL AMOUNT Requested ($USD)*
Other comments you wish to leave for consideration?
Signature - I hereby declare the above information is correct to the best of my knowledge and authorize ICPHSO to use this information as my submission for scholarship.*

Clear
Should be Empty:

2025 Annual Symposium Scholarship Request Form