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Insurance & Finance Intensive
Please complete the information below to register for the Triage Cancer Virtual Insurance & Finance Intensive on May 20, 2021.
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* Indicates required question
First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Address (Please note: Provide the mailing address that you would like hard copy materials sent.)
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Your answer
City
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Your answer
State
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Your answer
Zip Code
*
Your answer
Company/Organization
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Your answer
Title/Role
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Your answer
How did you hear about this intensive?
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Your answer
Are you a (please check all that apply)
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Oncology Social Worker
Oncology Nurse
Oncology Navigator
Advocate
Individual diagnosed with cancer (pre-treatment)
Individual diagnosed with cancer (in-treatment)
Individual diagnosed with cancer (post-treatment)
Caregiver
Other:
Required
Do you need an accommodation?
*
Yes
No
If you need an accommodation, please describe.
Your answer
Have you ever attended an event at which we presented? (check all that apply)
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Triage Cancer Webinar
Triage Cancer Conference
Triage Cancer Insurance & Finance Intensive
Triage Cancer In-Service Training - Navigating Cancer: Work & Insurance
Partner organization event
I have not attended an in-person Triage Cancer event before
Required
Have you ever utilized Triage Cancer educational resources? (check all that apply)
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Quick Guides and Checklists
Animated videos
Charts of state laws
CancerFinances.org
Triage Cancer Blog
State resources
I have not utilized Triage Cancer resources before
Other:
Required
Why are you in need of this training?
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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:
Required
How do you plan to use the information from the event?
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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:
Required
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?
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Yes
No
Given that space is extremely limited, we are requesting that attendees participate in the entire event. Do agree to participate in the entire day?
*
Yes
No
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