Conference / Training Scholarship Travel Form

Conference / Workshop Selection*

Select Scholarship*

Would you like to attend the APPA dinner at Fenway Park on Tuesday evening?

Yes
No

(cost will be covered by the scholarship)

Name (exactly as it appears on your driver's license)*

Enter your name exactly as it appears on your driver's license.

Gender*

Professional Title*

Member Community*

Email*

Travel Information

If you are signing up for a virtual conference, you can skip the rest of the form, scroll to the bottom and submit. However, if you would like to have WPPI book your travel to an in-person event, please proceed with the form.

Date of Birth

Home: Street Address

City

Zip

State

Cell Phone

Guest Name (exactly as it appears on their driver's license)

Gender - Guest

Guest Date of Birth

Transportation: Departure Date

Transportation: Return Date

Preferred Airport (1st choice)

Preferred Airport (2nd choice)

Preferred Airline

Frequent Flyer No.

Known Traveler No.

Seat Preference

Note to Travel Agent

Amtrak: Preferred Departure City

Hotel: Arrival Date

Leave blank if you prefer to book your own hotel room

Hotel: Departure Date

Leave blank if you prefer to book your own hotel room

Number of People in Hotel Room

Emergency Contact Name

Emergency Contact Phone

Will the guest be attending any part of the conference?

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