2013 Texas Forum on Blood Cancers
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11:15 a.m. Morning Breakout Session: [Type letter of breakout session in box below - choose only one.]
A. Integrative Oncology and Blood Cancer
B. Intimacy during Cancer Treatment
C. Understanding Your Treatment Coverage
D. Experiencing Cancer as a Family
E. When Cancer is Chronic: Learning to Manage the Ups and Downs
F. Not attending morning breakout session
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12:45 p.m. Lunch Panel: [Type letter of panel in box below - choose only one.]
A. Age 0-15
B. Age 16-39
C. Age 40-60
D. Age 61+
E. Not attending lunch panel
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2:00 p.m. Afternoon Breakout Session: [Type letter of breakout session in box below - choose only one.]
A. Care for the Caregiver
B. I'm not Crazy! I Just Have Cancer
C. Our Bodies, Our Selves: A frank discussion about body image and relationships during and after cancer (Young Adult Survivors Only)
D. Exercise in Survivorship
E. Living with Graft Versus Host Disease (GVHD)
F. Not attending this afternoon breakout session
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3:15 p.m. Afternoon Breakout Session: [Type letter of breakout session in box below - choose only one.]
A. Fighting Cancer with Nutrition
B. Late and Long Term Effects of Childhood Cancer
C. Developing your own Survivorship Care Plan
D. Balancing Cancer and Careers
E. You Can Impact the Future of Cancer Care - Advocacy
F. Not attending this afternoon breakout session
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Do you want to receive continuing education credits (nursing or social work)?
No (patients/survivors, caregivers, parents)
Nursing CEUs
Social Work CEUs
Other professionals can request a certificate of completion. Please indicate if you want a certificate of completion at the conclusion of the conference to submit to your professional board.
Yes
No
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License number (nurses and social workers - required). If not a nurse/social worker, please enter NONE:
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Who am I:
Patient/Survivor
Caregiver
Nurse
Social Worker
Other
If other, please explain here:
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Diagnosis:
None - caregiver, parent or professional
Non-Hodgkin Lymphoma
Hodgkin Lymphoma
AML - Acute Myelogneous Leukemia
ALL - Acute Lymphoblastic Leukemia
CML - Chronic Myelogneous Leukemia
CLL - Chronic Lymphocytic Leukemia
Multiple Myeloma
Waldenstrom’s Macroglobulinemia
Myelofibrosis
MDS - Myelodysplastic Syndromes
Other
If other, please explain here:
Year of diagnosis:
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How did you hear about the conference?
Brochure mailing
Website
Emailed invitation
Doctor's office
Other
If other, please explain here:
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Have you ever attended the Texas Forum on Blood Cancers Symposium?
Yes
No
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Do you need assistance with accessibility?
No
Yes
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Indicates Response Required