9361 Biliary Grand Rounds Registration

Thank you for your interest in Advances in the Diagnosis, Assessment, and Therapeutic Management of Biliary Tract Cancers (BTC). Please provide us with the following information so we can schedule your grand rounds.

1. Name of your hospital or institution *This question is required.

2. City *This question is required.

3. State *This question is required.

4. Host Contact Name *This question is required.

5. Host Contact Email *This question is required. This question requires a valid email address.

6. Host Contact Phone Number *This question is required.

7. Audience (Oncology, Hematology/Oncology, Fellows, etc.) *This question is required.

8. Number of Expected Attendees *This question is required.

9. Potential Dates (please provide more than 1 available date) *This question is required.

10. Potential Time

11. Would you like The France Foundation to provide CME credit? *This question is required.

12. This program is only available as a virtual presentation. Would you like The France Foundation to host via their Zoom platform? *This question is required.