* Last Name

* First Name and MI

* Address

* City

* State/Province

* Zip or Other Postal Code

Country if not US

Home Telephone

Work Telephone

* E-mail

Address where you can be reached after April 1 announcement date

Same as above

Address

City

Zip or Other Postal code

Country if not US

Please indicate how you plan to travel to the meeting
Airplane
Automobile
Bus
Rail

SSSP will support estimated air coach fare; auto travel at $.47 per mile; and travel by bus or train ONLY.

Please provide a breakdown of your anticipated costs to attend the meeting. Registration fees will be funded. Not all of the expenses for attending the meeting can be paid from these funds. SSSP strongly suggests that other sources of funds be sought to supplement your participation. Persons unable to attend the meetings MUST return all monies to SSSP.

Estimated Expenses

Travel cost

The committee will use the lowest available fare as the basis for its estimates of travel cost.

Room cost

SSSP will support a shared room at the SSSP conference hotel (roommate matching service will be available). Our room rate is $189 (US) plus tax per night. Exceptions will be made if extraordinary personal circumstances justify an individual room.

Meal cost

SSSP will support up to $15 US per day.

Grand Total

Please state why you consider yourself "underemployed," if applicable.

Please state your planned contributions to the meeting. ONLY SSSP members who have been accepted for program participation or participating as an elected or appointed officer or committee member will be considered.

Applicants will receive an e-mail confirming the receipt of their application. If you do not receive an e-mail within two weeks of submitting your application, please contact the chair, Michelle Budig. Applicants will be notified by the chair if their application was accepted/rejected no later than April 1, 2012.