Balancing Working & Cancer Webinar Series Registration - 2023

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: (Required.)

First Name

Last Name

Email address

Company/Organization (if applicable)

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2. Address (Required.)

Line 1

Line 2

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3. City (Required.)

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4. State/Territory: (Required.)

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5. Zip/Postal Code (Required.)

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6. Country: (Required.)

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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.) (Required.)

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8. Age (Required.)

Under 18

18 - 25

26 - 40

41 - 50

51 - 60

61 - 70

Over 70

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9. Which of the following best describes you? (Required.)

Woman

Man

Non-binary

Agender

Gender fluid

I don't know / I am not sure

Prefer not to answer

Prefer to self-describe (please specify)

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10. Are you transgender? (Required.)

Yes

Prefer not to answer

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11. What are your pronouns?

She/Her

He/Him

They/Them

Ze/Zir

Ze/Hir

Prefer not to answer

Prefer to self-describe

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

Asian or Asian American

Black or African American

Hispanic, Latinx, or Spanish origin

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White Non-Hispanic

Don't know

Prefer not to answer

Prefer to self-describe

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13. Do you / the patients you serve speak any language besides English fluently? (Required.)

Yes, I speak one or more other language(s) fluently

Yes, the population I work with speaks one or more other language(s) fluently

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14. If you answered "Yes" above:

I speak the following language(s) fluently

The population I work with speaks the following language(s) fluently

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

Prefer not to answer

Yes (please specify)

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16. Cancer treatment status (if applicable): (Required.)

Just diagnosed, pre-treatment

In-treatment, (1 year or less)

In-treatment, (1 year - 3 years)

In-treatment, (3 years - 5 years)

In-treatment (5 years or more)

Post-treatment (5 years or less)

Post-treatment (5 years or more)

Not diagnosed

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17. Please select all 2023 sessions you would like to register for (Required.)

All Sessions

Managing Long Term Stress — Wednesday, January 25, 2023 - 1:00 PM ET/10:00 AM PT

Making Key Decisions — Wednesday, February 8, 2023 - 6:00 PM ET/ 3:00 PM PT

Career Change — Wednesday, March 1, 2023 - 6:00 PM ET/ 3:00 PM PT

Balancing Remote Work and Cancer — Wednesday, April 19, 2023 - 1:00 PM ET/10:00 AM PT

Building Confidence at Work — Wednesday, May 3, 2023 - 1:00 PM ET/10:00 AM PT

Job Search — Wednesday, June 7, 2023 - 1:00 PM ET/10:00 AM PT

Self Care — Wednesday, July 12, 2023 - 1:00 PM ET/10:00 AM PT

Balancing Work and Cancer — Wednesday, August 2, 2023 - 6:00 PM ET/ 3:00 PM PT

Communicating Effectively: Part 1 — Wednesday, September 13, 2023 - 6:00 PM ET/ 3:00 PM PT

Communicating Effectively: Part 2 — Wednesday, October 4, 2023 - 6:00 PM ET/ 3:00 PM PT

Balancing Work and Caregiving — Wednesday, November 1, 2023 - 6:00 PM ET/ 3:00 PM PT

Marketing Yourself: Job Search and Beyond — Wednesday, December 6 - 1:00 PM ET/10:00 AM PT

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

No, I am NOT requesting a certificate of any kind

Yes, from the Association of Social Work Boards (ASWB)

Yes, from the New York State Education Department Board for Social Work (NYSED)

Yes, from the American Nurses Credentialing Center (ANCC)

Yes, from the California Board of Registered Nursing (CABRN)

Yes, from the Society for Human Resources (SHRM)

Yes, a general certificate of participation (No CEUs)

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* 1. Please provide the following information: (Required.)

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* 2. Address (Required.)

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* 3. City (Required.)

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* 4. State/Territory: (Required.)

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* 5. Zip/Postal Code (Required.)

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* 6. Country: (Required.)

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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.) (Required.)

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* 8. Age (Required.)

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* 9. Which of the following best describes you? (Required.)

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* 10. Are you transgender? (Required.)

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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. (Required.)

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

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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)? (Required.)

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* 16. Cancer treatment status (if applicable): (Required.)

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

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

1. Please provide the following information: (Required.)

2. Address (Required.)

3. City (Required.)

4. State/Territory: (Required.)

5. Zip/Postal Code (Required.)

6. Country: (Required.)

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.) (Required.)

8. Age (Required.)

9. Which of the following best describes you? (Required.)

10. Are you transgender? (Required.)

11. What are your pronouns?

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

13. Do you / the patients you serve speak any language besides English fluently? (Required.)

14. If you answered "Yes" above:

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

16. Cancer treatment status (if applicable): (Required.)

17. Please select all 2023 sessions you would like to register for (Required.)

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