* Your full name:
* Your six digit professional number:
* Your school/work site:
* Your contract status (Permanent, probationary, term):
* Your mailing address (including postal code):
* Your home phone number:
* Alternate phone number (work or cell):
* Your non-employer email address (NSTU preferred):
* Name of conference:
* Location of conference:
* Start date of conference:
* End date of conference:
* Brief description of conference:
* Conference website:
* Conference registration fee:
* Estimated travel cost:
* Estimated cost for accomodations:
* Estimated cost for meals:
* Have you applied for Article 60 funding?
* Have you been approved for Article 60 funding?
* Have you applied for or been approved for other sources of funding?
* If yes above, what type(s) of funding:
* Have you read and do you understand the guidelines for Halifax City Local PD funding?