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1. First Name (as on your passport)
2. Middle name (as on your passport)
3. Last name (as on your passport)
5. Passport country of issuance
6. Passport number
7. Date of birth (dd/mm/yyyy)
8. Passport issue date (dd/mm/yyyy)
9. Passport expiry date (must be min. end of January 2024; dd/mm/yyy)
10. Travel method: The grand majority of all travel to Rwanda will be via plane. If you are already in Rwanda, you will likely take a different method of travel depending on the distance from Kigali. - Do you need transportation to the conference?
11. Transportation information: For this conference, Women Deliver’s Professional Conference Organizer will book you to and from Kigali, Rwanda. The Expected Travel Dates are July 15th – July 21st. This allows you to attend the conference and all relevant pre-conferences. If you would prefer to depart at a later date, please explain which dates and for which purpose. Please note that your scholarship does not cover extended dates. If you decide to extend your travel, you would be responsible for all additional expenses including accommodation, food, transportation etc. The flight cost will still be covered, as long as it does not exceed the original price.
12. If you have different dates for departure from Kigali, please explain
13. Preferred date of departure from Kigali, Rwanda
14. Preferred airport of departure to go to the Conference
15. Preferred airport destination from Kigali
16. Food restrictions or allergies (for inflight meals)
17. How did you get your scholarship?
18. Per diem payment options: As a scholarship recipient you will receive the following: 1. The equivalent of $50 US per diem (per day) to cover meals and incidentals, based on the number of nights stayed at the Women Deliver-sponsored hotel. 2. A fixed amount stipend for travel expenses to and from your home airport, and the costs associated with obtaining a travel visa, should a visa be required. In the field below, please indicate how you would prefer to receive it. - How would you prefer to receive this payment?
19. If you chose bank transfer, please share the details requested. - Account name
20. Account type
21. Account number
23. Bank Swift Code
24. Bank ABA/routing number
25. Account currency
26. Bank name
27. bank beneficiary (as it appears on bank account)
28. Bank Address (Street incl number)
29. State, Province, Region
31. Postal Code
32. Intermediary Bank - Bank name
33. Intermediary Bank - Account name
34. Intermediary Bank - Routing number
35. Intermediary bank - Account number
36. If you chose PayPal, please share the requested details below. - PayPal Account email
37. PayPal Account name
38. Please note here any reasonable accommodation requests.
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