Travel Grant Application Form

2021 GACI Global Family Conference

Travel Scholarship Application Form

GACI Global New Year Meet-Up in Chicago

30th-31st December 2022

Embassy Suites Chicago Downtown Magnificent Mile

The GACI Global New Year meet-up is taking place in the Embassy Suites Chicago Downtown Magnificent Mile Hotel (511 North Columbus Drive, Chicago) on December 30th-31st. This beautiful hotel is very central, and the room rate includes breakfast.

Thanks to a generous events grant that we were awarded, GACI Global is able to provide travel grants to families attending the meet-up. A grant of $700 is available to families driving to the meet-up, and a grant of up to $1,000 is available to families flying to Chicago for the meet-up. As well as travel grants, GACI Global will cover the cost of some family-friendly activities on December 30th and 31st, and dinner on New Year’s Eve.

Families will book and pay upfront for their own hotels/travel costs and will be reimbursed up to the agreed travel grant (receipts required). This travel grant is open to families with surviving patients and also to those who have suffered the loss of a child to GACI. Grants are limited to one grant per patient family. The closing date for receipt of grant applications has been extended to Dec 2nd, 2022.

Travel Grant Application Form

"*" indicates required fields

First Name*

Last Name*

Email Address*

I am a:*

Patient with GACI/ARHR2

Parent/Caregiver of child affected by GACI/ARHR2

Patient's Name:*

I am:*

How are you traveling to Chicago?*

I am arriving on:*

When are you arriving?*

I am departing on:*

When are you departing?*

Number of adults attending?*

Name of second adult:*

Name of third adult:*

Name of fourth adult:*

Number of children attending?*

(children aged 17 and under)

Please tell us the name and ages of the children:

Child's Name:*

Child's Age:*

1st Child's Name:*

1st Child's Age:*

2nd Child's Name:*

2nd Child's Age:*

3rd Child's Name:*

3rd Child's Age:*

4th Child's Name:*

4th Child's Age:*

5th Child's Name:*

5th Child's Age:*

6th Child's Name:*

6th Child's Age:*

Do you have any special dietary requirements?*

Please tell us more information about any special dietary requirements that you have:*

Other information (optional)

Acceptance of Terms*

I accept the terms and conditions below.

1. This application is not a guarantee of an offer of a travel grant.
2. You must attend the New Year meet-up.
3. You must book and pay for your transport and accommodation expenses out of pocket. GACI Global is not responsible for making these arrangements.
4. Travel grants will be paid out two weeks after the New Year meet-up.
5. Travel grants will be paid by US$ check or PayPal to US recipients. Payment will be made via PayPal to non-US recipients.
6. Receipts required for reimbursement.

Phone

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2021 GACI Global Family Conference

Travel Scholarship Application Form

GACI Global New Year Meet-Up in Chicago

30th-31st December 2022

Embassy Suites Chicago Downtown Magnificent Mile

Travel Grant Application Form

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