Thank you for your interest in the HEMONC Fellows Training Series. Please complete this request form and we will contact your program's primary contact with further subscription details.By purchasing this product, you agree that you are licensing it for the number of subscriptions purchased. The contents of the course and any supplemental materials may not be reproduced, resold, distributed or shared in any way, nor used for group viewing.Group Payment Policy Payment in full must be received within 30 days of submission of this form. This includes payment via credit card, check, or wire transfer. GW reserves the right to apply a late fee to each registration or cancel the group registrations if payment is not received by the deadline. Please note: Your group will not receive access to the content until payment is received. Cancellation Policy If you cancel your online group registration within 7 days from purchase date, you will receive a full refund of the online course paid tuition minus a $50 cancellation fee. No refunds will be given or exchanges allowed for online course cancellations after 7 days from purchase date.There will be no refunds or exchanges for courses in which the content has been downloaded, CME test has been completed, and a certificate issued.Substitutions/name changes must be made by the group administrator via email at hemonc@gwu.edu. There is no charge for substitutions/name changes.Additional Questions Contact cehp@gwu.edu Institution/Organization * Address * Please provide your institution/organization's street address including city, state, and zip code. Is your billing address different than your mailing address? * Yes No Billing Address * Please provide your institution/organization's billing address including city, state, and zip code. Choose Subscription Type * Hematology and Medical Oncology Best Practices Hematology Best Practices Oncology Best Practices How many fellows would you like to enroll? * Contact Information Select the roles below which are applicable to your program, and provide contact information for each. * Program Director Associate Program Director Program Coordinator Program Director Name Program Director Email Address Associate Program Director Name Associate Program Director Email Address Program Coordinator Name Program Coordinator Email Address Primary Contact * The primary contact will be the main point of contact for invoicing and renewal reminders. Program Director Associate Program Director Program Coordinator License Agreement * By purchasing this product, you agree that you are licensing it for the number of subscriptions purchased. The contents of the course and any supplemental materials may not be reproduced, resold, distributed or shared in any way, nor used for group viewing. Leave this field blank
