Patient Training Workshop 2017
Patients have very personal perspectives on the risks and benefits of new treatments. Our Patient Advocacy Workshops will train patients and family members to better understand how research is designed so that they can be more effective voices on behalf of patients. We are offering a free 2-day workshop in June 2017 in Washington, DC. If you are interested, please complete this brief application.

If you are interested, please complete this brief application.

Email address
First Name
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Last Name
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Address(Please be sure to include the city, state and zip code)
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Phone
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1. Do you consider yourself a patient or a family member of a patient?
If you are a family member of a patient, please list your relationship.
Your answer
2. Why are you interested in learning about research and becoming a patient advocate on the national level?
Your answer
3. Are you currently involved with any patient advocacy organizations or consumer organizations? If so, please list the organization(s) and whether you are a member, a staff person or other affiliation.
Your answer
4. Please describe your experience as a patient advocate -- either with an organization or independently. Please highlight any experience you have with clinical trials, drug or device approvals, or other research issues.
Your answer
5. Are you available to attend our Introductory Patient Advocacy Workshop in Washington, D.C. on June 2-3, 2017? The 2-day workshop will start at 9 am on Friday, June 2 and end around 4 pm on Saturday, June 3. Workshop participants must commit to attending both days. Travel, hotel, and meals will be provided if you live more than 40 miles away.
6. Is there anything else you would like to tell us about your interest or experience for this workshop?
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7. Demographic Information
For administrative purposes, we are collecting demographic information. Please check all that apply:
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What is your age?
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Are you currently employed?
What is the highest level of education you have completed?
8. How did you hear about our Patient Training Workshop?
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A copy of your responses will be emailed to the address you provided.
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