Karen Mellor Bursary Application

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Personal Information

Name*

Email*

Phone*

Address*

Title (job, student, etc.)*

Questions

Identify your role, institutional affiliations and interest in smoking cessation research, clinical care, or other experience related to nicotine use disorder.*

How has nicotine use touched your life or the lives of people you know?*

How will receiving this bursary and attending the conference impact your work?*

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Date*

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Karen Mellor Bursary Application

Personal Information

Questions

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