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Cancer Burden Across Indiana: Connecting Molecular Mechanisms to Treatment, Care, and Community Registration Form

Please complete this form to register to attend the IU Simon Comprehensive Cancer Center's Cancer Burden Across Indiana: Connecting Molecular Mechanisms to Treatment, Care, and Community Symposium held on Thursday, June 26th.

The symposium is open to all, from researchers to trainees to community members. The symposium is from 7:30 a.m. to 4:30 p.m. in Walther Hall (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 presentation please complete this form by May 23rd. You will be subsequently contacted to provide your abstract.

The 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 form please contact Steven Verhagen at stverhag@iu.edu.

First Name

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Last Name

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Preferred prefix?

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Preferred email

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What is your institution?

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What is your Indiana University 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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We are accepting abstracts for poster and oral presentations until May 23rd at 11:59pm. Would you like to be considered to present at the symposium?

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Yes

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Are you a returning summer research intern? (have you participated in at least one previous Indiana University summer research program)

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Yes

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We are currently accepting abstract submissions for poster presentations from returning summer research interns. Would you like to submit an abstract to be considered for a poster presentation at this symposium?

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Yes

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Please list the names of one or more PIs/Research Mentors who you worked with to produce the research that you would like to present.

We are actively inviting sponsors to collaborate with us for this event. Would you like to receive information from us about sponsorship opportunities?

Yes

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We will have three afternoon small group breakout sessions:

From Molecules to Medicine:Understanding Variability in Cancer Outcomes
Connecting Bench to Bedside to Community: Enhancing Cancer Prevention and Treatment
Why Cancer Affects People Differently-and What We Can Do About It

Would you be interested in serving as moderator for one of these breakout groups?

Yes

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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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We will take photos and video footage during this event. Do we have your permission to use your photo or video?

Please review the Indiana University Media Release for more details.

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Yes

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Will you attend the Cancer Burden Across Indiana Symposium on June 26th, 2025?

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.