IU Simon Comprehensive Cancer Center's Cancer Health Disparities Symposium Registration Form

Please complete this form to register to attend the IU Simon Comprehensive Cancer Center's Cancer Health Disparities Symposium on Tuesday, June 18th. The symposium is open to all, from researchers to students to community members.

The symposium is from 9:45 a.m. to 4 p.m. in Walther Hall at 980 W. Walnut St. Indianapolis, IN 46202. A light breakfast and lunch will be provided. This meeting is in-person only.

To be considered to give a talk, please complete this form before May 6. You will be subsequently contacted to provide your abstract.

The IU Simon Comprehensive Cancer Center's Cancer Health Disparities Symposium is co-organized by the center's Office of Inclusive Excellence and the Cancer Research Training and Education Coordination Core. For questions about the symposium please contact Dr. Daenique Jengelley at djengell@iu.edu. For help with this survey please contact Steven Verhagen at stverhag@iu.edu.

First Name

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Last Name

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Preferred email

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What is your institution?

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What is your other institution?

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Which option best describes you?

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How would you describe your professional position?

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What is your lab affiliation?

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Are you an IU Simon Comprehensive Cancer Center member?

What is your IUSCCC membership type?

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We will have afternoon small group breakout sessions, please select from below the discussion groups which you would be interested in joining.

Community Engagement

Translational Research

Population Science

Clinical Research

Basic Science

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Would you be interested in being a discussion group leader?

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At this time, the symposium is accepting abstracts for oral presentations from experts in cancer research and/or clinical care with a focus on:

Social Determinants of Health
Genetic and Biological Determinants of Health Disparities
Health Equity
Culturally Aware Research Practices
Community Engagement
Health Policy
Other Health Disparities-based research

Would you like to be considered to give a talk during the symposium?

By selecting "Yes" you will be contacted to provide an abstract for your proposed talk.

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Please list any dietary restriction you have of which we should be aware.

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Please list any accommodations you require of which we should be aware.

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Will you need garage parking validation?

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Yes

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Will you attend the IU Simon Comprehensive Cancer Center's Cancer Health Disparities Symposium on June 18?

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