Child Health Research Institute
2019 Pediatric Cancer Research Group Symposium
Child Health Research Institute
2019 Pediatric Cancer Research Group Symposium Form
* Denotes required field
Applicant Information
*
First Name
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Last Name
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Email Address
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Phone Number
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Address
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City
*
State
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Zip Code
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Select Your Status
(Please Select)
Faculty
Resident/Fellow
Medical Student
Other Health Care Professional
Philanthropist
Administrative Personnel
Other
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If Other, Please Specify
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Employed or Student of UNMC?
Yes
No
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UNMC College or Institute
Department
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Select Which Events You Intend to Attend
August 26 - Poster Session - 4:00PM - 6:00PM - Truhlsen Atrium Foyer
August 27 - Morning Session - 8:30AM - 11:30AM - Truhlsen Event Center Large Ballroom
August 27 - General Symposium Luncheon - 11:45AM - 12:30PM - Truhlsen Event Center Large Ballroom
August 27 - Coalition Luncheon - 11:45AM - 1:30PM - Truhlsen Event Center Small Ballroom
August 27 - Afternoon Session - 12:45PM - 5:30PM - Truhlsen Event Center Large Ballroom
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Are You a Member of the Nebraska Coalition to End Childhood Cancer?
Yes
No
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Do You Need Special Accommodations
Yes
No
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Please Specify
*
Do You Need a Vegetarian or Gluten-Free Meal?
Vegetarian
Gluten-Free
No
If you have any questions, please contact Lisa Runco at
lisa.runco@unmc.edu
.
