Karen Mellor Bursary

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Personal Information
Name*
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Questions
Identify your role, institutional affiliations and interest in smoking cessation research, clinical care, or other experience related to nicotine use disorder.*
How has nicotine use touched your life or the lives of people you know?*
How will receiving this bursary and attending the conference impact your work?*
Consent
Confirmation*
I have read the terms and conditions of the CSAM-SMCA Scientific Conference Bursaries and hereby certify that the information provided in this application is correct. I understand that any false statements made in any part of this application may be sufficient cause for rejection of my application or withdrawal of a bursary award.*
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