Patient Permissioning and Directives Workshop (Registration)

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Registration

Please register below to participate in the workshop.

In-person space is limited, please make your request to join us, via registering, by November 13th, confirmation for in person attendance will be sent no later than November 18th.

 

OMB No.: 0925-0740
Expiration Date: 11/30/2028

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0740). Do not return the completed form to this address.

Your Information
Title
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I will be attending:
Are you an NIH badge holder, a U.S. Citizen, or a U.S. Permanent Resident (Green Card holder)? (Select “Yes” if any apply.)

Attention: Visitors who are not NIH Badge Holders, U.S. Citizens or Permanent Residents with a green card must submit documentation of a U.S. Visa or Visa Waiver Program at least 30 days prior to their visit to the NCI facility. You will receive an email with instructions shortly after submission of this form. Please be advised that failure to submit the required form at least 30 days before your scheduled arrival may result in denial of entry to the NCI/NIH campus.

 

Additional Registration Questions
Request for Reasonable Accommodations
View the definition of reasonable accommodations