Webinar Request Form

Please fill out the information below if you are seeking to present a webinar on information related to current clinical trials, patient education or other related topics. Please contact Melinda Bachini at melinda.bachini@cholangiocarcinoma.org for more information.

Are you representing an…(Required)

Organization

Individual

Do you have a non-disclosure agreement in place with CCF?(Required)

Yes

Title of the Presentation(Required)

Patient-Friendly Summary of the Presentation(Required)

Preferred Month of Presentation(Required)

Preferred Time of Day

Presenter Information

Name(Required)

First Last

Title(Required)

Company/Institution(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Presenter Brief Bio(Required)

Presenter Headshot

Max. file size: 36 MB.