Cancer Center

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Register Today for the First Annual Clinical Research Symposium


Saturday, October 4, 2014  • Conference Room M, Froedtert & MCW Clinical Cancer Center

This half-day Clinical Research Symposium will present topics of interest to promote education and advancement of Clinical Research staff. Check in and breakfast begin at 7:15 AM and the symposium will adjourn at 12:30 PM.

Registration cost is $25 per person.  Registration deadline is September 26th.  Seating is limited to the first 75 paid registrants.  Pre-registration is required, so please complete the entire form below and hit the "Submit" button on the bottom left-hand side of this page. 

Please contact Paulette Jacobs with any questions at (414) 805-4594 or pjacobs@mcw.edu.

1. Attendee Information

First Name   Last Name    Credentials  

Institution    Department  Position or Title 

 
Phone Number   Email 

How long have you been involved in clinical research?  What is your disease focus area?  

Any special needs (dietary, access, audio or visual needs, etc.)?  

 
 
2. Payment Information & Instructions
 
Please select payment type  and follow the specific instructions below.
 
CTO Staff Member (Adult CTO): Payment for Cancer Center CTO staff members is processed automatically via internal transfer.  No further action is needed.  Please click the submit button below to complete registration. 

Internal Transfer, Other MCW Staff: If you are paying by internal transfer a number must be provided. This is a Cost Center, Natural Account, Fund or Grant Number. The transfer will be $25 to the MCW Cancer Center Clinical Trials Office. Registration will be complete upon approved and completed transfer of funds. The Department Administrator or Business Manager will be e-mailed and asked to confirm that payment for this course has been approved. Internal transfers occur from MCW departments.  Remember, a NUMBER MUST be provided as only MCW departments can initiate an internal transfer of funds. 

Please enter an account number to be debited: 

Name of Department Administrator or Business Manager 

email of Department Administrator or Business Manager 

Check Payment: If paying by check, please send a $25 check, payable to the MCW Cancer Center, to Paulette Jacobs, Clinical Trials Office, Clinical Cancer Center, 8701 Watertown Plank Road, Milwaukee, WI, 53226.  Registration will be complete upon receipt of check. 

 

3. Complete Registration Form by Clicking the 'Submit' Button Below

Registration deadline is September 26th.  Seating is limited to the first 75 paid registrants. Please contact Paulette Jacobs with any questions at 414-805-4594 or pjacobs@mcw.edu. 

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Page Updated 09/08/2014