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...*
- Organization
- Individual
Do you have a non-disclosure agreement in place with CCF?*
- Yes
- No
Title of the Presentation*
Patient-Friendly Summary of the Presentation*
Preferred Month of Presentation*
Preferred Time of Day
Presenter Information
Name*
First Last Suffix
Title*
Company/Institution*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Presenter Brief Bio*
Presenter Headshot
Max. file size: 36 MB.

Webinar Request Form

Presenter Information