apply for patient stipends

Patients can apply for stipends to attend advocacy conferences. You must belong to an organization that is a part of our Autoimmune Registry Network in order to be apply.

If you would like to donate to our Patient Stipend Fund, please contact us.

Name

First Name

Last Name

Affiliated Organization

Do you belong to an organization that is a part of the Autoimmune Registry Network?

Yes

Patient Advocacy Conference Name

Conference Website

http://

Please briefly introduce yourself and indicate how you will be using the stipend. (required)