2023 Webinar Registration Form

NOTE: Register for our final 2023 session (Marketing Yourself) below. To register for 2024 sessions, click here.
Cancer and Careers respects and protects the privacy of all visitors and users of our services. Cancer and Careers is the sole owner of any information collected through its programs. All information submitted will only be viewed by the Cancer and Careers staff and no identifying information will be shared publicly. 
 
We strive to create programs and services that represent and serve the full diversity of the cancer community. We are asking the following demographic questions to ensure that we are meeting this goal.

If you require reasonable accommodations to attend this event, kindly email us at cancerandcareers@cew.org with the subject line "Reasonable  Accommodation Request."

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* 1. Please provide the following information:

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* 2. Address

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* 3. City

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* 4. State/Territory:

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* 5. Zip/Postal Code

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* 6. Country:

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* 7. What is your phone number? (If you plan on dialing-in to access sound, please specify the phone number you will be calling from.)

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* 8. Age

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* 9. Which of the following best describes you?

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* 10. Are you transgender?

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* 11. What are your pronouns?

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* 12. Which of the following best represents your race/ethnicity? Please select all that apply.

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* 13. Do you / the patients you serve speak any language besides English fluently?

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* 14. If you answered "Yes" above:

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* 15. Have you yourself been diagnosed with cancer? If so, which type(s)?

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* 16. Cancer treatment status (if applicable):

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* 17. Please select all 2023 sessions you would like to register for

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* 18. Are you planning to request free continuing education credits (CEs/PDCs) or a general certificate of participation?

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