The Cancer Convergence: High School Participant Registration Form

October 24 | 9:00 a.m. - 1:00 p.m.
Hosted by the University of Vermont Cancer Center

The Convergence is about the future of cancer research and how interdisciplinary approaches have, are, and will provide new technologies, directions, questions, and impacts upon treating and curing cancers.

As a component of this year's gathering, we're welcoming local high school students to learn more about careers in cancer.

RSVP required by Friday, October 7. We’ll be in touch with more details closer to the date.

Preferred Name *

Last Name *

Pronouns (e.g. they/them)

Email Address *

Phone Number

Please choose your preference from the lunch menu below. *

Turkey & Cheddar Sandwich (turkey, cheddar cheese, lettuce and tomato)

Ham & Provolone Sandwich (ham and provolone cheese with lettuce and honey mustard on a roll)

Vegetable & Hummus Sandwich (lettuce, tomato, peppers and hummus)

Please let us know about any dietary restrictions (e.g. food allergies):

In order to fully participate in the program, will you need any accommodations (e.g. ASL Interpreter Services/CART)?

Would you be interested in learning more about cancer research opportunities through the UVM Cancer Center?

Yes

No

Photo Release Waiver *

I hereby give full permission for the use of my/my son/daughter's name and photograph in connection with this event, and agree and understand The University of Vermont may video, record and photograph The Convergence events, and I authorize The University of Vermont irrevocably, to edit, copy, distribute, publish for any purpose--via any media, such as websites, printed materials, multi-media presentations, etc.--those videos, recordings, and photographs or any parts thereof. Additionally, I waive the right to royalties or other compensation arising or related to the use of the photo. If I am under the age of 18 years, this Photo Release Waiver agreement has been reviewed and signed on my behalf, and agreed to, by my parent or guardian.

I agree with the terms and conditions above.

I do not agree with the terms and conditions above.

Set Primary Affiliation with UVM to 'Cancer Center Affiliate' (Internal Only)

Student Financial Services

The Cancer Convergence: High School Participant Registration Form