EmailMe Form - Bob Luther Scholarship Application

Name *

First Last

Credentials (RCC, FRBMA, etc...)

Email *

Company *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Preferred Phone *

### - ### - ####

Short Essay Questions

Please respond to the three questions below (50-100 words)

Provide details of your recent accomplishments: *

What are your future radiology business career goals? *

Why do you want to attend an RBMA National meeting? What do you believe you'll gain from attending? *

Document Uploads

Letter of Reference *

Resume / Curriculum Vitae *

Agreement

Please affirm the following:

1. Your availability to attend 2024 PaRADigm, April 14-17, 2024
2. Your understanding that should you be selected, you will receive a complimentary conference registration and $1,000 in reimbursement of documented travel expenses.
3. Your understanding that you are required to stay in the conference hotel, the MGM Grand, Las Vegas, Nev., as part of the terms of the scholarship.
4. After attending the conference you will submit a short essay (200-300 words) on your experience at PaRADigm. *

Yes, I affirm

Signature

Clear