VBCF - Sponsorship Application




				Virginia Breast Cancer Foundation Sponsorship Application VBCF has a limited amount of funding available to defray the cost of travel and hotel accommodations for members interested in attending educational conferences. Sponsorships are awarded on a competitive basis. VBCF is not able to provide assistance to everyone who applies. Those requesting sponsorship funds must submit this application and letter of agreement, with a copy of the Conference registration form. Deadlines for receipt of applications will be determined on a conference-by-conference basis. Applications that are incomplete or are received after the deadline will not be considered. Title of Conference: Date of Conference: Location: Name: Today's Date: Address: City, State, Zip Code: Work Phone: Home Phone: E-mail Address: Are you a member of VBCF? Yes No Are you currently involved with VBCF and/or a VBCF Chapter? Yes No Are you a graduate of NBCC's Project LEAD? Yes No Have you attended VBCF sponsored events (including teleconferences) in the past? If so, which ones? Have you ever received a sponsorship from VBCF? Yes No If YES, what conference(s) and year(s)? Are there any other advocacy efforts that you're currently involved in? If so, please explain: Cost Estimates: Hotel: $ Transportation: $ I plan to arrive on: I plan to depart on: This is a total of overnights. Hotel expenses are based on double occupancy. If you prefer a room of your own, you must pay for the difference yourself. TOTAL ESTIMATED COST: The Virginia Breast Cancer Foundation will reimburse up to 2/3rds of total cost. If full financial assistance is needed, please contact the VBCF office. You are responsible for the conference registration fee and your meals. Please include a brief statement describing why you would like to attend the conference: Letter of Agreement and Expectations: In return for sponsorship funds from the Virginia Breast Cancer Foundation, we require that you: Be a registered member of VBCF (If you are not currently a member, please contact VBCF for a membership application). Represent VBCF in a professional manner and serve as a representative of our organization. Fully participate in the conference by attending all plenary and workshop sessions. Must do at least ONE of the following: Be an active member of one of VBCF’s chapters Serve on at least one of VBCF’s Committees which meet regularly at VBCF offices or via conference call. Draft an article OR provide detailed information on the conference for VBCF’s newsletter, which VBCF reserves the right to edit as needed. Give a verbal presentation following the conference to either the VBCF Board or a VBCF Chapter. Complete the sponsorship application and letter of agreement, and submit to VBCF by the deadline set by VBCF for your target conference. I agree with the terms of the Letter of Agreement and Expectations: Yes No You will be notified as soon as possible as to the status of your sponsorship.