Contact Information - Delegate
Salutation
-- Please Select --
 
 
Post-nominal letters
 
 
First Name
  
 
Last Name
  
 
Title
 
 
Company / Institution
  
 
Department
 
 
Address 1
  
 
Address 2
 
 
City
  
 
Province / State
-- Please Select --
  
 
Country
Canada
  
 
Postal Code / Zip
  
 
Telephone
  
 
Email Address
 
Re-enter Email Address
 
 
Demographics
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.
Gender
-- Please Select --
  
 
Preferred Language

(Select all that apply)
 
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?
-- Please Select --
(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?
-- Please Select --
  
 
How did you first hear about the Canadian Cancer Research Conference?
-- Please Select --
  
 
Have you attended any previous Canadian Cancer Research Conferences?





(Select all that apply)
 
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?
  
 


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