The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

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Required format:

pGa4pnax7hzkM9i9Wjsk4RCKy2WzIuNXEUSCv9z49hPkg5CmrBub7wrGIe738pjs2Nq8HpPU3x

Community Presentation Request Form

Huntsman Cancer Institute values the people and organizations who are committed to improving the health of our communities, families, friends, and neighbors. We are excited to support your efforts and to provide resources and accurate health education about cancer risk, prevention, and care.

Presentations are available virtually (pre-recorded and live) and in person. Please indicate on the form which you prefer.

To better serve you, please provide us with more information by filling out the Presentation Form below. To be considered, requests must be received at least 30 days prior to a presentation. Please allow 5-7 business days for a response.

Name of Group or Organization

* must provide value

Group or Organization Website

* must provide value

Contact Name

* must provide value

Phone number

* must provide value

Email Address

* must provide value

Address

Address 2

City/Town

State/Province

Other

ZIP/Postal Code

Presentation Date

* must provide value

M-D-Y

Presentation Start Time

* must provide value

How many people are expected to attend?

* must provide value

Presentation Format

In-person

Live (virtual)

Pre-recorded (virtual)

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Presentation Duration

15 Minutes

30 Minutes

45 Minutes

1 Hour

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Language of Requested Services/Materials

English

Spanish

Both

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Describe the general audience of this event (i.e. LGBTQ+, American Indian, Hispanic/Latino, seniors, teens). You can list multiple where applicable.

* must provide value

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Topic/Cancer Focus (Select all that apply)

Breast Cancer

Cancer Prevention and Screening

Cervical Cancer/HPV Vaccination

Clinical Trials

Colorectal Cancer

Head and Neck Cancers

Lung Cancer/Radon

Prostate Cancer

Skin Cancer

Presentations are subject to being moved to an online format or rescheduled within 10 days of the presentation date, in accordance with current COVID-19 and public health notices, guidelines, and the health of staff.

If choosing a virtual option, Huntsman Cancer Institute can provide the platform to facilitate the presentation if needed. Information regarding how to access the presentation will be sent via email to the email address listed above. The information regarding how to join the presentation will then need to be distributed among attendees by the requesting organization.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.