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World Congress of Gerontology Student Travel Fund

The International Association of Gerontology has established the World Congress of Gerontology Student Travel Fund to assist students from around the world to participate and attend the World Congress of Gerontology. If you would like to contribute to this fund, please print this page and complete the form below.

I would like to contribute $_________ to the World Congress of Gerontology Student Travel Fund.

Your name: _________________________________________________________

Address: ___________________________________________________________

City: Province/State: ___________________________________________________

Postal Code: ________________________________________________________

Email: _____________________________________________________________

Phone Number: ______________________________________________________

Fax Number: ________________________________________________________

Method of Payment:  [_] Cheque  [_] Money Order 

[_] Credit Card:   [_] VISA  [_] MasterCard

Card Number: _______________________________________________________

Expiry Date: _________________________________________________________

Signature: __________________________________________________________

Mail or fax this form to:

(former) IAG Secretariat
Gerontology Research Centre
Simon Fraser University
2800-515 West Hastings Street
Vancouver, British Columbia
CANADA V6B 5K3

Fax 604-291-5066

Cheques should be made payable to the International Association of Gerontology with a note indicating the money is to be used for the World Congress of Gerontology Student Travel Fund.