CleanMed 2010 Conference Scholarship

CleanMed 2010 Conference Scholarship (www.cleanmed.org)
CleanMed 2010 Conference will be held in Baltimore, MD May 11^th through the 13^th.
Scholarships to cover registration fee of $575.
Scholarship Application Due Friday, March 26, 2010

Your Full Name: *

Your Title: *

Contact Information: *

Please provide your primary phone number, mailing address, and email address.

Hospital Affiliation: *

Why would you like to attend CleanMed 2010?: *

(max 250 words)

How did you hear about this scholarship opportunity? : *

Green Initiatives and Sustainability Knowledge: *

What is currently taking place at your healthcare organization regarding sustainability? Please list any green initiatives that you are aware of.

Do you have or will you be able to receive management approval for your travel and attendance at the entire CleanMed 2010 conference (May 11-13)? : *

Yes

Green Teams: *

Is there a green team in place currently at your hospital or plans to implement one?

Others Interested?:

Please list the names of anyone else in your organization whom you think may be interested in programs about sustainability in healthcare.