Cancer Genomics Consortium

2024 Trainee/Technologist Confirmation Form - Cancer Genomics Consortium

Trainee and Technologist Status Confirmation Form

Please have your Mentor / Instructor / Supervisor submit this confirmation when you complete your membership registration, meeting registration, or abstract submission.

The contact information at the top of the form refers to the person completing the form. The request for the name of the trainee or technologist is later in the form.

First Name *

Last Name *

Email *

Name of Applicant Trainee or Technologist: *

If the applicant is a trainee, Training Program Description:

Institution: *

Mentor / Instructor / Supervisor Work Phone:

Mentor / Instructor / Supervisor Mobile Phone: *

Mentor / Instructor / Supervisor Email Address: *

I confirm the trainee or technologist applicant qualifies for a CGC 2024 Annual Meeting Outstanding Trainee or Technologist Award, or a reduced rate for CGC membership and/or event registration because they are: *
Choose 1

Mentor / Instructor / Supervisor
Please type your name here to serve as your signature verifying the information entered above: *

Consent:

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