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Advocate Scholarship Application

April 15, 2019

Lyme & Other Tick-Borne Diseases: 20th Annual Scientific Update for Clinicians & Researchers

Who is eligible to apply

LDA has a limited number of scholarships to offer. You have been sent a link to this page because your name has been suggested to Lyme Disease Association, Inc. (LDA) as a possible scholarship recipient based on your Lyme disease education work and financial need. You are not permitted to share this link with anyone else or you may lose your eligibility to be considered for a scholarship.

What is the scholarship for

To enable participation in the LDA/Columbia CME Conference “Lyme Disease Association’s 20th annual Lyme & Other Tick-Borne Diseases Scientific Conference” (September 21 & 22, 2019, Philadelphia, PA)

Why is this scholarship being provided

Our goal is to disseminate knowledge obtained from the conference to as many people as possible. Such knowledge stimulates novel research ideas, forges collaborations, and enhances clinical care.

Deadline

LDA must receive the application from you by June 30, 2019 to be considered for a scholarship. Applicants will be considered on a first come first serve basis until the funds are depleted.

How will the scholarships be awarded

Scholarships will be awarded at the sole discretion of the Lyme Disease Association, Inc. (LDA). If the information you provided is found subsequently to be untrue, you will be required to reimburse the LDA for the full cost of the scholarship award.

How will the scholarship will be administered

The LDA will notify you of its decision. If you are accepted, detailed instructions will be sent to you. Reimbursement policies will be sent to you at the time of acceptance.

Total of scholarship including registration fee, hotel, and transportation will not exceed $1,000. ALL expenses are incurred by you upfront for conference registration, hotel and transportation. Accepted applicants will need to submit an LDA reimbursement form after the conference with all receipts attached to receive eligible reimbursement up to $1,000.

How to Apply

The online application form below must be received by June 30, 2019 (12M ET). Questions email [email protected]

2019 LDA Conference Advocate Scholarship Application

Name*
First Last
Home Address*
Street Address City State ZIP Code
Email*
Phone (cell preferred)*
Fax (if any)
Organization you Represent or Advocacy Roll*
Your Title in Organization*

e.g. Officer, trustee, Board of Director, member
Organization Online Info

Website, Facebook or twitter url's
Organization Address
Street or PO Box Address Line 2 City State ZIP Code
How do you expect to use the information you learn at conference in your advocacy work?*
Confirm*
I certify that I have a financial hardship that prevents me from attending the conference without a scholarship.
Confirm*
I understand all costs are my responsibility upfront and LDA will reimburse, after the conference, up to $1,000
How would you travel to the conference?*
- Own car
- bus
- train
- plane
- other
Will you require a hotel room*
- Yes
- No
Hotel room needed for what date/dates?
- Friday 9/20
- Saturday 9/21
Download the W-9 form here.
Personal W-9*
Max. file size: 32 MB.
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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THANK YOU!
This activity is supported by independent educational grants from:

Steven & Alexandra Cohen Foundation

2019 Scientific Conference Jointly Provided by

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About LDA DOCTOR REFERRAL SYSTEM ©
Welcome to the Lyme Disease Association’s LDA Doctor Referral System ©. LDA made updates and enhancements to its prior system and has launched a new site to provide patients with information about doctors, other practitioners, testing labs, and pharmacies that are knowledgeable about chronic Lyme disease and often about many other tick-borne diseases (TBD). Many of the doctors listed are often referred to as Lyme Literate Physicians/Doctors (LLMD). Tens of thousands of patients have successfully used the prior LDA system to locate Lyme and TBD resources.

Terms & Conditions and Guidelines
Because there is a negative political climate surrounding Lyme disease, many LLMDs do not want their names posted outright on the internet. LDA has tried to balance the doctors’ wishes with patients’ need to find a doctor. This new system is a result of that compromise and therefore:

LDA permits searches over a calendar month period that will result in access to up to 15 Doctor Referrals. To access a Doctor Referral listing, first conduct a search, and then click on the desired provider from the results that populate. Clicking on a listing will re-direct you to that provider’s page which will include all necessary contact information. The system enables you to click on up to 15 Doctor Referrals every calendar month period.
Searches can be refined based on the search location (street address, city, zip code or country), search radius (distance from the starting point), category filter(s), and/or keyword search.

Because of the limited number of physicians treating chronic Lyme disease nationwide, some states, and in some instances, entire regions, may not have any treating physicians who follow flexible treating approaches such as those in the International Lyme & Associated Diseases Society (ILADS) Guidelines, Evidence Assessments and Guideline Recommendations in Lyme Disease: The Clinical Management of Known Tick Bites, Erythema Migrans Rashes and Persistent Disease. In the event that the LDA Doctor Referral System © contains no Lyme or TBD resource listings in a given area, the closest possible option(s) will populate based on the location entered and specaialty/ies selected. The LDA appreciates any changes in provider information that you may find and make us aware of so we can investigate.

Some providers may not specifically treat Lyme and TBD but see patients who have symptoms associated with Lyme and TBD to address those specific symptoms. Contact the provider to confirm.

It is your responsibility to contact the provider’s office to confirm the current address, directions, nature of services provided, and all other provider information before you make an appointment.

DISCLAIMER: The Lyme Disease Association, Inc. provides referrals to health care providers who treat Lyme disease, and often other TBD, as a courtesy to those seeking Lyme Literate Physicians (LLMD). However, some of the providers included do not specifically treat Lyme and TBD but see patients who have symptoms associated with Lyme and TBD to address those specific symptoms. We do not evaluate the professional competence or qualifications of health care providers on our referral list or the costs of services provided. Accordingly, the LDA neither warrants nor endorses the health care providers contained on this list nor the quality of care you will receive from those providers. We do not make recommendations, only referrals. LDA does not receive any monies from physicians to be included on this list nor does LDA provide any monies to physicians. Because of the limited number of physicians treating chronic Lyme disease nationwide, some states, and in some instances, entire regions, may not have any treating physicians who follow flexible treating approaches such as those in the International Lyme & Associated Diseases Society (ILADS) Guidelines: Evidence Assessments and Guideline Recommendations in Lyme Disease: The Clinical Management of Known Tick Bites, Erythema Migrans Rashes and Persistent Disease. In the event that the Doctor Referral System contains no Lyme or TBD resource listings in a given area, the closest possible option(s) will populate based on the zip code entered and category/ies selected. The LDA appreciates any changes in provider information that you may find and make us aware of.

LDA does not accept or reply to any comments on:

What insurance a doctor accepts or does not accept, or if any insurance is accepted.
How listed doctors practice or any other aspect of the doctor-patient relationship.
The cost or fees charged by any healthcare provider.
Why a particular doctor is or is not listed.
Request for providers that treat COVID-19, although some of the providers in the system may treat COVID.

We cannot guarantee that the information provided will be timely and accurate or that physicians on the list are accepting new patients, or that they accept insurance. The selection of a physician should be made by you after careful consideration. There are two approaches in the treatment of Lyme disease. Our list contains physicians who generally follow more flexible treatment approaches than those advocated by the Infectious Diseases Society of America (IDSA). LDA is not responsible for incorrect information on the website. BEFORE DOCTOR VISIT: Please contact the physicians’ offices directly to confirm their current address, directions, and any other necessary information before scheduling an appointment. Do not rely only on the maps provided on this site. The maps on LDA’s Doctor Referral System are for informational purposes and provide an approximate locality of the listing based on the addresses we are provided with at the time of site updates. Practitioners often relocate and addresses can change. Notification of changes in listed information can be updated on our Dr. Referral Contact Form. Thank you, Lyme Disease Association, Inc. (LDA)

Subscriber information will not be shared outside of the Lyme Disease Association, Inc. nor used for donor solicitation.

The Lyme Disease Association, Inc. reserves the right to unsubscribe anyone from this service without cause.

Please use our Dr. Referral Contact Form regarding any issues.

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