********* REGISTRATION IS NOW CLOSED *********
Registration for the Los Angeles Cancer Rights Conference is now CLOSED. You may still complete this registration form to be added to our waiting list.

The CLRC will NOT notify you of any registration openings. You are welcome to show up on the day of the conference to see if there are any openings available. If there are any registration openings available on the day of the conference, they will be assigned on a first come, first served basis.

If you are unable to attend the conference, please consider attending the CLRC's upcoming free teleseminar/webinar series. These seminars will cover many of the subjects that will be discussed at the Cancer Rights Conference, and you can participate from the comfort of your own home or office. We also hope that you will join us for our 2011 Cancer Rights Conferences (dates to be determined soon!). To register for our free teleseminar/webinar series, visit the CLRC website events page at www.CancerLegalResourceCenter.org (click on the "events" tab at the top of the page).



Please complete the following registration form.

Note: Any statistical information provided (Ethnicity, Gender, Age, etc.) will be kept anonymous and will only be used for research purposes in a group format. The CLRC uses this information to write grants for the continued funding of our organization and will allow us to continue to provide free services such as our annual Cancer Rights Conferences.

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First Name (Required.)

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Last Name (Required.)

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Organization

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Title

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Address (Required.)

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City (Required.)

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State (Required.)

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Zip Code (Required.)

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Phone Number xxx-xxx-xxxx (Required.)

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Alternate Phone Number xxx-xxx-xxxx

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Email Address

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Are you a:

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Ethnicity

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Gender

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Age

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Do you need Spanish translation?

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Do you need accomodations (dietary restrictions, physical access, etc.)?

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How did you hear about this conference?

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What is one thing you hope to learn or take away from this conference?

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