Conference Student Travel Support Application Form Student Information First Name Last Name Address Phone Fax E-mail Address Degree Information Name of Degree (Ph.D. or M.S. or Bachelor’s) Start Date (MO/YR) Expected Graduation Date (MO/YR) Thesis Title Thesis Description(1-2 sentence description of thesis work) Conference Presentation Information Paper Title Abstract Designation (e.g. AB-10) Paper Authors Are you the presenting author? Travel Expense Budget Information Airfare Lodging Food Other Expenses Support from Other Sources Have you received a travel award for a previous MMM or Intermag conference? If yes: Name of Conference Conference Year Will you be staying in the conference hotel? Advisor Information First Name Last Name Address Phone Fax E-mail Address