Seminar Scholarship Form

Don Kuhn and Joyce Behrens Memorial Scholarship Application

ASCLS-Washington offers a Memorial Scholarship of $40.00 to attend the Northwest Medical Laboratory Symposium on October 24 - 25, 2024 or the Joint Spring Seminar in April 2025. The scholarship covers the registration fees for this meeting. Applicant must be a current member of ASCLS living in Washington State. Scholarship application deadline for the NWMLS is October 15, 2024. If you are registered for the 2024 NWMLS, we will reimburse the successful applicants.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
ASCLS member number
Employer
Have you received the ASCLS-WA Memorial Scholarship before?

yesno
Have you attended a Spring Seminar or NWMLS?

yesno
If not, why have you not attended in the past?
Why do you want to attend the symposium, and how would it benefit you as a professional and in your current job?
What member benefits of ASCLS-WA interest you most?
Please send an email to Brenda Kochis when you have completed this form. Email is BrenKoch@comcast.net. This will ensure that we process your application as soon as possible.
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Don Kuhn and Joyce Behrens Memorial Scholarship Application