Question Title

First name *

Question Title

Last name *

Question Title

Phone number *

Question Title

Address *

Question Title

Are you currently in a fellowship training program? *

Question Title

Institution name *
If you are not currently in a fellowship training program, please write "N/A"

Question Title

What is your level of interest in lung cancer on a scale of 1–5, 1 being “Not interested at all” and 5 being “Very interested”? *

Question Title

About what percentage of your clinical time is dedicated to lung cancer patients? *

Question Title

Are you currently involved in thoracic oncology research (e.g., clinical trials, translational work, publications)? *

Question Title

In what ways do you hope to influence the future of lung cancer care over the next 5-10 years? *

Question Title

Have you published, presented at national meetings, or contributed to educational content? *

Question Title

What do you hope to gain from participating in a program focused on clinical thought leadership and professional networking? *

Question Title

What topic area are you most interested in learning more about? *

Question Title

Please share your LinkedIn profile *
Please include the full address starting with https://

Before completing your application, please read and agree to the terms below:

Question Title

I agree that after I have confirmed my availability to attend the program, I will attend the program sessions in full and complete required pre- and post-meeting surveys. *

Question Title

I understand that failure to send a cancellation request or attend the Rising Stars Fellows Program in full may result in ineligibility to attend future HMP-hosted programs. *

Question Title

I agree to submit my travel itinerary including flight information as soon as I have confirmed my availability to attend the program or by the published deadline, July 1st. *

T