2020 Triage Cancer Conference Travel Assistance - Atlanta, GA
Please answer the following questions to apply for travel assistance to attend one of the 2020 Triage Cancer Conference in Atlanta, GA on October 3rd. Triage Cancer agrees to keep all information provided in this application confidential and it will not be shared outside of the selection committee. If you have questions, please email info@TriageCancer.org. Thank you and we look forward to seeing you there!
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First Name *
Last Name *
Email Address *
Information about the conference will be sent to this email address.  Triage Cancer will not share your email address with anyone.
Phone Number *
If Triage Cancer cannot reach you via email, your phone number will be used to communicate with you about the conference.
Street Address *
City *
State *
Zip Code *
Are you a (please check all that apply) *
Required
Age *
Gender *
Type of Cancer *
Required
Work Status *
Required
How did you hear about these conferences? *
Approximately how many miles are you traveling to attend the conference? *
Please describe your need for travel assistance and your financial situation: (For example, what financial hardships have you experienced as a result of your cancer diagnosis, do you have any ongoing financial hardships like medical bills, student loans, etc.?) *
Please describe what you hope to gain from attending the Triage Cancer Conferences and how you think you might be able to share the information you learn with your community. *
Is there anything else you would like to share with the selection committee?
I agree to attend the entire conference *
I agree to provide a brief testimonial about my conference experience in writing or on video. *
By typing my name below, I certify that all the information included is accurate to the best of my knowledge. *
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