The Ehlers-Danlos Society is providing a limited number of scholarships for the EDS ECHO Summit Series (Community Days). Registration scholarships include access to the event app and all privileges of a full paying attendee for the remaining events in the series, as well as access to the recordings for the previous events in the series. Please note these are virtual events, and a device with internet connection is necessary. Applications will be accepted through May 16, 2021 (until midnight, Eastern Time US/Canada). The Society’s office will review applications as they are received. You will be notified directly of acceptance by email. If you are unable to accept, we ask that you inform the Society’s staff as soon as possible, to allow someone else to benefit from the scholarship. Please fill out all parts of this form. We look forward to hearing from you.The series of Community Days includes:Pain Management, Community Day, April 25, 2021 (access to recordings)Rarer Types, May 29, 2021vEDS, Community Day, July 31, 2021Neurology, Community Day, September 26, 2021Allergy/Immunology, Community Day, December 5, 2021INFORMATION USE Information you provide in this form will be used only by staff of The Ehlers-Danlos Society for the purposes of determining scholarship grants, and will be maintained for five years. You will be contacted solely for event information related to your scholarship application, unless you specifically choose to join our mailing list as well.Email* Name* Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Middle Last Suffix Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*What is your annual household income?*Only numbers will be accepted in this field.In which currency did you report income?*Use symbols or words. Examples: US$ or US dollars, AUS$ or Australian dollars, € or euros.How many people live in your household?*Include yourself.Have you attended a Society conference before?*YesNoWhy do you want a scholarship? What would a scholarship mean to you?*Do you wish to receive CONNECT, our newsletter, and other emails from The Ehlers-Danlos Society?*YesNoCAPTCHA
