2015 AHMA Conference
Travel Scholarship Application


The third annual patient conference of the American Headache and Migraine Association will be held in Washington, D.C., on Sunday, June 21 from 8:00 a.m. to 6:30 p.m.

More information about the conference and a link to the registration page can be found on our conference page.

The AHMA realizes that attending this conference is not financially within reach of all of our members. We have, therefore, pulled together the funding to offer a limited number travel scholarships of up to $500 each to help cover transportation, conference hotel, and meals.

About the scholarships:

  • Scholarship recipients must be at least 18-years-old.
  • There are people who absolutely cannot attend without financial assistance. Please do not apply for a scholarship if it is possible for you to attend without this assistance.
  • Each scholarship is intended for one patient. It does not include a companion.
  • Scholarships can be applied to hotel costs for the night before the conference and the night of the conference only.
  • Scholarship recipients are expected to travel to and from the conference by the least expensive mode of travel.

All scholarship recipients will be required to:

  • write 500 to 1,000 words about their conference experience, to be published on www.AHMABlog.com.
  • complete a W-9 form. Recipients will receive a 1099 form for tax purposes.
  • keep and submit copies receipts for travel, conference hotel, and meals.
  • submit copies of receipts along with any unused portion of the scholarship funding.

If you want to apply for one of the travel scholarships, please
complete the form below. All parts of the form are mandatory.

Please note: The conference is a benefit of AHMA membership;
therefore, you must be a member of AHMA
to apply for these scholarships.
If you aren't an AHMA member, join HERE
.

The deadline for scholarship applications is Tuesday, March 31, 2015.

Finalist scholarship candidates will be interviewed by phone the first part of April, and scholarships will be awarded the middle of April.

BEFORE you apply: Research and determine how much it would cost for you to attend the conference, and be sure that you would be able to attend if you receive one of the scholarships.


All fields are mandatory. Applications submitted without your name and email address cannot be considered.

First Name:   Last Name:  

Street Address:  

City:     State:     Zip Code:   -

Email Address:*       Phone Number:*    -   -  
*Your email address and phone number will not be shared with anyone, but you must provide them for your application to be considered.

Date of Birth:  Month      Day     Year  

Are you . . .? (please check one): Patient       Family       Friend
                             Other Please specify:  

Have you researched travel costs, etc., to be sure that a $500 scholarship will allow you to attend the conference?  Yes      No

What is your personal history with Headaches or Migraines?
Mandatory length: 250 - 500 words.


Why do you want to attend this conference?
Mandatory length: 250 - 500 words.


After the conference, how would you use what you learned?
Mandatory length: 250 - 500 words.

 

By clicking the submit button, you are entering into a binding contract with the American Headache and Migraine Association. You certify that you are at least 18-years-old. You agree that if you are awarded a scholarship, you will attend the 2015 AHMA Conference and write about your experience as described above. You also agree that if you cannot attend, you will give as much advance notice as possible so that the scholarship can be awarded to another qualified candidate. If you are awarded a scholarship and are unable to attend, you agree to return the scholarship money, in full, no later than July 15, 2015. Any unused or refunded scholarship funds will be sent, by July 15, 2015, to:

The American Headache and Migraine Association
c/o American Headache Society
19 Mantua Rd.
Mount Royal, NJ 08061

Scholarship awardees must complete and return the provided W-9 form by fax to 1-800-884-1300 or email to conference@ahmblog.com within 48 hours of notification of being awarded the scholarship.

After you click the Submit button, your browser will go to the home page of AHMA chair Teri Robert's site, Help for Headaches and Migraine, where this form is hosted.