Contact Information - Delegate
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Post-nominal letters
First Name
Last Name
Company / Institution
Address 1
Address 2
Province / State
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Postal Code / Zip
Email Address
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We aspire to be a more inclusive conference. To identify who we need to work harder to reach and include, we need to understand the demographics of our audience. We will use this data to make improvements and to be more inclusive in future conferences.
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Preferred Language

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Do you identify as a person with a disability?

(referring to people who experience long-term, persistent or recurring physical, mental, sensory, psychiatric, or learning disabilities, including those with chronic health conditions, which may result in a person encountering barriers to participating in society)?
If Yes, which of the following best describes your disability related barriers?

Please indicate which of the following terms best describe your racial and/or ethnic identity

(terms listed above chosen to reflect terms used in the Canadian census). Select all that apply.
Do you identify as an Indigenous person in Canada?
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(defined as First Nations (status or non-status), Inuit, and Métis)?
What is your research focus?

(Select all that apply)
Which of the following best describes you?
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How did you first hear about the Canadian Cancer Research Conference?
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Have you attended any previous Canadian Cancer Research Conferences?

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Future Contact?
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Do you give permission to the CCRA to use registration contact information for future dissemination about the conference and/or other CCRA initiatives?