Clone of Registration Form - Not Your Father's CLL

Register Below for 'Not Your Father's CLL', to be held at the Mayflower Hotel, Seattle, WA

GRACE invites you to register for 'Not Your Father's CLL'

Webcast Live

for patients and caregivers living with Chronic Lymphocytic Leukemia

Time and Date	Location
April 22, 2016	Mayflower Hotel
11:00 a.m. PT, 2:00 p.m. ET	Seattle, WA

Join GRACE faculty member Dr. John Pagel and a local live group of patients and caregivers for 'Not Your Father's CLL', to be webcast LIVE from Seattle, WA on April 22, 2016, at 11:00 a.m., Pacific Time. We will connect CLL patients and caregivers with leading oncologist Dr. John Pagel, chief of the Hematologic Malignancies program for the expanded treatment and research of blood-based cancers such as leukemia, multiple myeloma and lymphoma at Swedish Cancer Institute. Dr. Pagel will speak about current treatment options and the future of care, and will learn directly from forum attendees about their experiences and concerns. Webcast is free. Your registration allows us to send you a webcast reminder via email.

View the Agenda (subject to change)

Registration is Free*

*Your registration authorizes GRACE to send reminder and follow up emails for this event.

Time and Date	Location
April 22, 2016	Mayflower Hotel
11:00 a.m. PT, 2:00 p.m. ET	Seattle, WA

Join GRACE faculty member Dr. John Pagel and a local live group of patients and caregivers for 'Not Your Father's CLL', to be webcast LIVE from Seattle, WA on April 22, 2016, at 11:00 a.m., Pacific Time. We will connect CLL patients and caregivers with leading oncologist Dr. John Pagel, chief of the Hematologic Malignancies program for the expanded treatment and research of blood-based cancers such as leukemia, multiple myeloma and lymphoma at Swedish Cancer Institute. Dr. Pagel will speak about current treatment options and the future of care, and will learn directly from forum attendees about their experiences and concerns. Webcast is free. Your registration allows us to send you a webcast reminder via email.

View the Agenda (subject to change)

Registration is Free*

*Your registration authorizes GRACE to send reminder and follow up emails for this event.

Full Name*

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E-mail*

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Please Provide your Postal Code/Country for our records.*

2. What do you hope to learn at the Patient Forum? (limit to 500 characters)

Global Resource for Advancing Cancer Education (GRACE)Society for Immunotherapy of Cancer (SITC)Melanoma Research Alliance (MRA)Other

Please fill in the box below to pay your registration fee via paypal.

Registration $25.00

If you are registering for more than one person, please provide their name/names here:

Registration fee*

Registration for the Immunotherapy Patient Forum November 7, 2015$25.00

How many people are you registering for?

If you were provided a registration code by a member of the GRACE, MRA or SITC staff, enter it below$25.00

Total $0.00

The Immunotherapy Patient Forum for the Treatment of Melanoma, Leukemia, Lung and Genitourinary Cancers will be recorded. Your attendance at this event implies your permission for images and AV recordings captured during these sessions to be used for purposes of SITC, MRA, and/or GRACE archival, educational, promotional materials and publications, and waives your rights for compensation or ownership of these images.

GRACEMRASITC

GRACE, MRA and SITC would like to thank the following companies for their support of this forum.

Advocacy Partners

The Immunotherapy Patient Forum for the Treatment of Melanoma, Leukemia, Lymphoma, Lung and Genitourinary Cancers is supported in part by grants from Amgen; Bristol-Myers Squibb; Genentech; Merck KGaA, Darmstadt, Germany and Pfizer; and Merck & Co., Inc.