HSANZ and Zoie Moore Research Foundation ASH Travel Scholarship

Please complete this form to apply for the HSANZ & Zoie Moore Research Foundation Travel Scholarships to ASH 2026.

Before you begin this form, please ensure you have all the information needed to complete submission as you are unable to save and return to this form.
1. About the applicant
Name

First NameLast Name
Residential Address

Street Address

Street Address Line 2

CityState

Post CodeCountry
Mobile Phone Number
Email
example@example.com
HSANZ Membership - please tick the boxes below that represent your current membership status
2. Your abstract / presentation at ASH
Please select the type of presentation you will be giving at ASH 2026

Other
Title/s of your presentation / poster
Statement of relevance to haematology and alignment with ZMRF's research objectives, particularly blood cancer research.
Please declare any other travel funding you have received or have applied for.
Should be Empty:

1. About the applicant