256 S. Occidental Blvd., Suite B
Los Angeles, CA 90057
Direct Line: 866-THE-CLRC (866-843-2572)
Fax: 213-736-1428
Video Relay Phone: 213-908-1079
E-mail: CLRC@DRLCENTER.org
www.CancerLegalResourceCenter.org
The CLRC is a program of the Disability Rights Legal Center
Event Request & Material Order Form
The CLRC provides seminars, teleconferences/webinars, professional programs, and attends
outreach events throughout the country. If you would like the CLRC to participate in your next event
or would like us to send you materials, please complete this form and return it by fax, email, or mail.
Organization Name ___________________________________________________________________
Contact Name _______________________________________________________________________
Address (Event Location Address) _______________________________________________________
City, State, Zip _______________________________________________________________________
Contact Phone # ________________ Fax # ______________ Email ____________________________
Event Name_________________________________________________________________________
Event Date (choice #1) ________ Event Date (choice #2) _________ Event Date (choice #3) ________
Event Time _______________ Seminar Length _____________ Expected attendance #____________
Audience (check all that apply): Survivors Caregivers Health Care Professionals General
Public  Seminar (in-person)  Teleconference/Webinar (by phone or computer)
 In Spanish
Please indicate the requested presentation topic(s):
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About the Cancer Legal Resource Center
Cancer & the Law (national or state-specific)
Health Insurance & Health Care Options
Understanding Health Care Reform
Employment & Taking Time Off Work
Education Rights of Children & Young Adults
Disability Insurance
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Medicare
Insurance Navigation (appeals, etc.)
Estate Planning
Life Insurance
Genetics & the Law
Legislative Advocacy
Continuing Legal Education
Will there be access to a computer/projector?
Yes
No
The CLRC is run by a non-profit that operates, in great part, through grants and donations. If your
organization is able to contribute to travel, lodging, or an honorarium, your assistance will greatly help the
CLRC’s continued services in the cancer community. Regardless of a contribution, the CLRC will make its
best effort to participate at your event.
Sorry, we do not have the funds at the moment
Yes, we can cover:
Travel
Lodging
Honorarium
Material Request Please indicate the date by which you would like to receive the materials _____________
 CLRC Intake Line Business Card (English) _____
 CLRC Bookmark (English) _____
 CLRC Information Sheet (English/Spanish) _____
Please visit www.CancerLegalResourceCenter.org for additional materials available to
download for free.
Cancer Legal Resource Center Seminar Topics
Seminar topics can cover national and/or state-specific information and can be provided in English or Spanish.
Overview: Cancer Legal Resource Center: This is an introduction to our history, our mission, and the
services we offer to cancer patients, survivors, caregivers, and healthcare professionals. Suggested time:
15-30 minutes
Cancer and the Law: In this presentation we discuss the most common cancer-related legal issues for
cancer patients and survivors, including: health insurance options; employment rights and reasonable
accommodations in the workplace; taking time off work; and access to disability insurance and government
benefits, such as Medicare, Medicaid, Supplemental Security Income (SSI), and Social Security Disability
Insurance (SSDI). Suggested time: 45 minutes – 2 hours
Health Insurance: This is a seminar on the health insurance options available to people with pre-existing
medical conditions and coverage issues. These options include COBRA, state COBRA plans, the Health
Insurance Premium Payment Program (HIPP), the Health Insurance Portability & Accountability Act
(HIPAA), high risk pools, Medicaid, Medicare, the Women’s Health & Cancer Rights Act (WHCRA) and
other relevant healthcare laws. Suggested time: 45 minutes – 1 hour
Understanding Health Care Reform: This seminar will help attendees understand the changes to our
health care system contained in the latest national health care reform efforts. Learn about new health
insurance options available to children, young adults, and adults with pre-existing conditions and new
protections related to rescissions, annual limits and lifetime caps on coverage, and access to clinical
trials. In addition, this seminar will cover new requirements for coverage of preventative care and new
Medicare benefits.
Employment & Taking Time Off Work: In this comprehensive overview, we cover the rights and
protections of employees (including caregivers) in the workplace under the Americans with Disabilities Act
(ADA), state fair employment laws, the Family and Medical Leave Act (FMLA), and state leave laws.
Suggested time: 45 minutes – 1 hour
Estate Planning: The purpose of this seminar is to help people prepare for any potential situation by
planning ahead to ensure that their loved ones and assets are protected. It provides an overview of
advanced health care directives, powers of attorney for financial affairs, conservatorships, wills and trusts,
and life insurance. Suggested time: 45 minutes – 11/2 hours
Disability Insurance: This is a presentation on the benefits available to people who are temporarily or
permanently unable to work, and what eligibility requirements they must meet under private disability
insurance, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), state disability
insurance options, and state paid family leave programs. Suggested time: 45 minutes – 1 hour
Medicare: This presentation covers all aspects of Medicare coverage, including standard Medicare,
Medicare/Medicaid, Medigap plans, Medicare Advantage plans, eligibility for clinical trials and preventive
services under Medicare, and the Medicare Part D prescription drug plan. Suggested time: 1 – 2 hours
Insurance Navigation: Discover effective ways to deal with your health insurance provider to get the care
you need. Learn about your rights with respect to accessing your medical records, second opinions, and
the internal and external appeals processes. Suggested time: 45 minutes – 1 ½ hours
Genetics and the Law: This presentation covers the legal protections for those with a genetic
predisposition to cancer, focusing on the fields of employment and insurance. Suggested time: 15-45
minutes
Legislative Advocacy: Examine how to affect legislative change as an individual, small group, or an
organization. We discuss pending legislation, the legislative process, and how to contact and effectively
communicate with the elected officials. Suggested time: 45 minutes – 1 ½ hours
Continuing Legal Education: This seminar provides an overview of cancer-related legal issues and how
to participate on the CLRC’s Professional Panel. Suggested time: 1 – 2 hours
*Customized seminars are also available upon request, based on interest and audience.