LGSOC Patient Conference Scholarship Request
All information shared within this form will be kept confidential. Completing this form does not guarantee that STAAR Ovarian Cancer Foundation will provide funds to help you attend the conference. We will reach out to you by January 6, 2025 with information on whether or not we can help you with your trip. We are working on obtaining sponsors to cover travel expenses for LGSOC patients who need help.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Back
Submit
Next
With what do you need help in order to attend the conference? (choose all that apply)
*
Airfare
Accommodations
If you selected the airfare above, what is the current airfare price for you to travel to the conference?
Should be Empty: