Virtual Breast Cancer & Heart Disease Advocate Program (VAP) Fall 2024 Registration

REGISTRANT INFORMATION

First Name

Last Name

Phone Number

- College/University Email

Must provide STUDENT EMAIL ONLY - Registrations made with personal email addresses will not be processed.

Please retype your college/university email:

Address 1

City

State

Zip / Postal Code

Country

Birthdate

Age

I am over 18 years of ageI am NOT over 18 years of age

COLLEGE & CLASS INFORMATION

The Virtual Advocate Program is currently only offered for currently enrolled college students.

I am a currently enrolled college student

College / University

College University Campus

Course Code

Must be Complete Course Code as seen in your Syllabus (i.e., NUR2680)

Professor

VALID Professor's Email

Your registration will be rejected without a valid professor email address.

† In order to participate in the Virtual Breast Cancer & Heart Disease Advocate Program, you must register using your college/university e-mail and enter the name of your academic institution, the course code for any class you are taking this semester, and the related professor's name at the time of this submission. Please note that you must register at least 24 hours in advance to attend all webinars.

Click to the next page to select your session date and time.

Page 2

WHAT DATE WILL YOU ATTEND THE WEBINAR?

Please select the date and time you will attend the webinar.

Times are in Eastern Standard Time.
Please prepare for a two-hour commitment.

Why are you participating in VAP? (Please select all that apply):

Required CourseCourse Extra CreditCommunity/Service Learning Hours

Contact Information