2025 Insurance & Finance Intensive Registration

Please complete the information below to register for the Triage Cancer Insurance & Finance Intensive.

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Phone

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* 5. Street Address

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* 6. City

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* 7. State

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* 8. Zip Code

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* 9. Company/Organization (if applicable)

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* 10. Title (if applicable)

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* 11. How did you hear of this training?

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* 12. Are you a (please check all that apply)

Social Worker

Nurse

Navigator

Community Health Worker

Advocate (e.g., Certified Patient Advocate, staff of advocacy organization)

Financial Counselor/Navigator

Attorney

HR Professional

Caregiver

Individual who is considered high risk/seeking preventative services

Individual diagnosed with cancer (pre-treatment)

Individual diagnosed with cancer (in-treatment)

Individual diagnosed with cancer (post-treatment)

Individual diagnosed with cancer (metastatic)

Individual with a medical condition other than cancer (please specify below)

Other (please specify)

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* 13. What age range applies to you?

0-18

19-39

40-64

65+

Prefer not to share

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* 14. I identify my race/ethnicity as

Native American

Asian or Pacific Islander

Black or African American

Hispanic or Latinx

Middle Eastern or North African

White

Prefer not to answer

Other (please specify)

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* 15. What gender do you most identify with?

Woman

Man

Transgender

Non-binary/non-conforming

A gender not listed here

Prefer not to answer

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* 16. If you need an accommodation, please describe:

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* 17. Have you ever attended an event at which we presented? (check all that apply)

Triage Cancer or Triage Health Webinar

Triage Cancer or Triage Health Conference

Triage Cancer or Triage Health Insurance & Finance Intensive

Triage Cancer In-Service Training - Navigating Cancer: Work & Insurance

Partner organization event

I have not attended a Triage Cancer or Triage Health event before

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* 18. Have you ever utilized our educational resources? (check all that apply)

Quick Guides and Checklists

Practical Guides to Cancer/Healthcare Rights

Animated videos

Charts of state laws

CancerFinances.org

Blog

Legal & Financial Navigation Program

I have not utilized Triage Cancer or Triage Health resources before

Other (please specify)

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* 19. Why are you in need of this training? (Check all that apply)

Patients ask me these questions

To better help my patients navigate these issues

To increase my understanding of these topics

To advocate for policy and legislative changes related to these topics

Free continuing education

Other (please specify)

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* 20. How do you plan to use the information from the event? (Check all that apply)

To better help my patients navigate these issues

To advocate for policy and legislative changes related to these topics

To help a family member or friend navigate these issues

To help myself navigate these issues

Other (please specify)

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* 21. Due to the interactive nature of this program, we require attendees to participate via computer with a webcam. If accepted, do you agree to participate via computer with a working camera?

Yes

N/A I am attending an in-person training

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* 22. Given that space is limited, we are requesting that attendees participate in the entire event. Do agree to participate in the entire day?

Yes

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* 23. I agree that if I share the information learned at this event, I will provide proper credit to Triage Cancer.

Yes