Travel Reimbursement Application.

Instructions:
Please complete all required fields. Provide accurate travel and financial information. By submitting this form, you acknowledge and agree to the Conditions of Acceptance, including funding decisions, media use, and post-event sharing. All medical information provided will be kept confidential and used solely to confirm eligibility for travel reimbursement. Only one application per family/household. The Foundation to Fight H-ABC/TUBB4A reserves the right to verify information provided.