Insurance & Finance Intensive
Please complete the information below to apply to attend the Triage Cancer Virtual Insurance & Finance Intensive on November 4, 2019. Please note: completing this application does not guarantee acceptance.
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First Name *
Last Name *
Email Address *
Phone Number *
Title/Role *
Company/Organization *
Address *
City *
State *
Zip Code *
How did you hear about this intensive? *
Are you planning on requesting free continuing education credits? *
Do you need an accommodation? *
If you need an accommodation, please describe.
Have you ever attended an in-person event at which we presented? (check all that apply) *
Required
Have you ever utilized Triage Cancer educational resources? (check all that apply) *
Required
Why is it difficult for you to attend an in-person Intensive program that we are hosting for the remainder of 2019? *
Why are you in need of this training? *
How do you plan to use the information from the event? *
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? *
Given that space is extremely limited, we are requesting that attendees participate in the entire event. Do agree to participate in the entire day? *
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