2025 SSMR Arnold Belker Memorial Traveling Award Application Form

2025 SSMR Arnold Belker Memorial Traveling Award

Application Form

Please submit this application along with the required documents in 1 PDF by February 28, 2025.

Recipient will receive:

$1500 travel stipend to the upcoming AUA meeting, awarded after the meeting.
Abstract Summary in SSMR Fall Newsletter
Complimentary SSMR Banquet ticket - (TBD)

Name*

(Last, First)

Date of Application*

Email*

Accepted AUA Abstract title*

Accepted AUA Abstract Presentation Date and time

Please add if known.

Secondary Email

Degree(s)*

Address*

City*

State*

ZIP code*

Work Phone*

Cell Phone*

Current Position*

Fellowship Program or Institution*

Eligibility*

Please select one.

Current Infertility Fellow

One year out of Infertility Fellowship (working in research or clinical practice)

Accepted into 2024-2025 Infertility Fellowship

File Upload*

Please upload the following requirements as 1 PDF document and label with LAST NAME.

• Curriculum Vitae

• Copy of abstract that was accepted at the AUA (include title & presentation day/time below)

• Letter of recommendation from Fellowship Program Director

• Personal Statement describing career path, interest and future plans. (100-200 words, 1 page or less)

Drag and drop files here or

I agree*

Applicant Consent By agreeing below, I understand that attendance at the AUA, SSMR meeting and SSMR banquet will be subsidized by the award to a maximum of $1,500, and that attendance of the fellow at the SSMR meeting and SSMR banquet is expected.

Send me a copy of my responses

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