Travel Fellowship Form

Application for Travelling Fellowship/Grant


Full Name	:
Hospital Address	:
Day Telephone (Incl Area Code)	:
Email Address	:
Present apponitment (Consultant, SpR etc)	:
Destination	:
Itinerary	:
Projected Costs (Rough breakdown into travel, accommodation and subsistence.)	:
Reasons for travel (What benefits are anticipated to develop from the visit ie. local, regional or national.)	:
If overseas, what advantage that has to visiting a UK centre?	:
Has study leave been approved and any expenses borne by your department?	:

NASGBI TRAVEL FELLOWSHIP