2024 Webinar Registration Form

Cancer and Careers respects and protects the privacy of all visitors and users of our services. Cancer and Careers is the sole owner of any information collected through its programs. All information submitted will only be viewed by the Cancer and Careers staff and no identifying information will be shared publicly.


We strive to create programs and services that represent and serve the full diversity of the cancer community. We are asking the following demographic questions to ensure that we are meeting this goal.


Material presented at Cancer and Careers’ Balancing Work & Cancer Webinar Series is copyrighted so the use of AI assistants and/or transcribing/recording devices of any kind by attendees is not allowed. Those found to be using AI or other recording/transcription software during CAC programming will be removed from the event. They may be permitted to return without AI/recording/transcription software.


Cancer and Careers offers live, real-time closed captioning for those who need it, and captioned recordings of all Balancing Work & Cancer Webinars are archived on our website following each session. To request an additional reasonable accommodation, please send an email to cancerandcareers@cew.org at least 24 hours before the live session.

If you require reasonable accommodations to attend this event, kindly email us at cancerandcareers@cew.org with the subject line "Reasonable Accommodation Request."

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Phone Number (If you plan on dialing-in to access sound, please specify the phone number you will be calling from.)

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* 5. Mailing Address

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* 6. City

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* 7. State/Territory (If outside the United States, please select "Other" at the bottom of the dropdown menu and type in state/province and country)

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* 8. Zip Code

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* 9. Country:

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* 10. Company/Organization (If applicable)

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* 11. Title (If applicable)

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* 12. Age

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* 13. Which of the following categories, if any, apply to you?: (Please check all that apply.)

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* 14. Treatment Status (If applicable)

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* 15. Cancer Type (If you have never been diagnosed, please type "N/A".)

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* 16. Which of the following best describes you?

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* 17. Are you transgender?

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* 18. What are your pronouns?

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* 19. Are you Hispanic, Latine, or Spanish descent? 

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* 20. Which of the following best represents your race/ethnicity? Please select all that apply.

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* 21. Do you / the patients you serve speak any language besides English fluently?

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* 22. If you answered "Yes" above:

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* 23. Have you ever served in the U.S. military or the military reserves?

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* 24. Employment status:

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* 25. Please select all 2024 sessions you would like to register for

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* 26. Are you planning to request free continuing education credits (CEs/PDCs) or a general certificate of participation?

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