The National Conference on Wilderness Medicine

Student Scholarship Application

Scholarship recipients will receive complimentary registration for the meeting and will be asked to work closely with conference management staff in a variety of ways including: registering conference attendees, answering questions regarding the conference schedule and location of workshops, ushering attendees to the proper locations, checking registrants into workshops, selling shirts and jackets and other miscellaneous tasks. We will do our best to schedule these tasks so that our student scholars can attend all lectures.

Please note: Applications will be reviewed on a first come first serve basis (preference may be given to early applications).

Applicant Contact Information
Full Name*
Date*
Month
Day
Year
Which conference are you interested in attending?*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Cell Phone*
Email*
Where are you currently enrolled?*
What type of program are you in?*

(Medical, Nursing, PA, NP school etc.)
Have you been awarded one of our scholarships in the past?*
- Yes
- No
If yes, when?
Have you previously attended a Wilderness Medicine course?*
- Yes
- No
If yes, when?
Have you been involved with emergency medicine or wilderness medicine in medical school? (Please describe your involvement)
Please share why you want to attend this conference and what you hope to gain from attending. (Please describe)
Please share any experience you have with customer service. (Please describe)
Reference Information
Please list two professional references (faculty, perceptor, etc) that we may contact.
Name
Institution
Cell Phone
Email
Name
Institution
Cell Phone
Email
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to a scholarship, I understand that false or misleading information in my application may result in my release.
Signature*
Date*
Month
Day
Year

Thank you for your interest in attending The National Conference on Wilderness Medicine. If you have any questions, please call 844-945-3263 or email info@wilderness-medicine.com.

The National Conference on Wilderness Medicine

Student Scholarship Application

Applicant Contact Information

Reference Information

Disclaimer and Signature