Please complete the below form to register for the 2025 SGM Cancer CARE Workshop in Denver Colorado. SGM Cancer CARE Workshop Registration Name* First Last Name as you would like it to appear on badge* Professional Email* Personal Email* BNGAP username*If you have not yet registered for BNGAP.org, please write "Not registered" Position/Title* Degree* Mailing Address* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificOtherZip Code* CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwePhone* Race/Ethnicity*Select all that apply Asian Black/African-American Hispanic/Latino Native American/Alaskan Native White Specify if Race/Ethnicity not listed Gender Identity*Male/ManFemale/WomanTransmale/TransmanTransfemale/TranswomanGenderqueer/Gender nonconformingSpecify if Gender Identity not listed Sexual Orientation*BisexualGay or lesbianQueerStraight or heterosexualSpecify if sexual orientation not listed Please list your pronouns as you would like them to appear on your name badge* I would like to be included in a directory of researchers interested in SGM cancer research.*YesNoPlease select your SGM cancer research interests* Adolescent and Young Adult Alcohol Behavioral Health Research Breast Cancer Cancer Diagnosis Cancer Prevention Cancer Screening Cancer Survivorship Cancer Treatment Cervical Cancer Clinical Trials Colon Cancer Community Based Participatory Research eHealth / mHealth End of Life Care Epidemiology Exercise / Nutrition / Obesity Leukemia / Lymphoma/ Liquid Tumors Lung Cancer Prostate Cancer Solid Tumors SOGI Data Collection Tobacco Vaccines Emergency Contact. Please provide name, relationship, and phone number*We will supply you with a copy of the book, "Cancer and the LGBT Community." Please indicate your preferred version for delivery.* Print Copy Digital Copy Please indicate if you would like a printed or digital version of the workshop materials* Printed Version Digital Version Please list any food allergies Arrival Date* Anticipated Hotel Arrival Time (N/A if not requiring a hotel stay)* Departure Date* Departure Time Food Preference No preference Vegetarian Vegan Pescatarian I will bring my own food Are there any reasonable ADA accomodations we can provide for you?Please attach your headshotMax. file size: 32 MB.Please include your professional bio (200 word maximum)Do you consent to any photos taken during the workshop to include your image on workshop advertising and promotional materials? Yes No Is there anything else you want us to know before you attend the workshop? Please describe hereEmailThis field is for validation purposes and should be left unchanged.