Southwestern Ontario Chapter Meeting- September 17, 2025

Support Program

Thank you for taking the time to register for the Southwestern Ontario Chapter Meeting on Wednesday, September 17, 2025. Please fill out the following information for registration.

If you have any questions or experience any difficulty in completing this registration form, please contact gurjot@lymphoma.ca.

Question Title

* 1. Contact Information

First Name: *

Last Name:

City/Town:

ZIP/Postal Code: *

Email Address: *

Phone Number:

Question Title

* 2. Please indicate your interest in lymphoma (you may select all that apply).

I have Hodgkin lymphoma

I have Follicular lymphoma

I have Diffuse Large B-Cell lymphoma

I have Marginal Zone/MALT lymphoma

I have Mantle Cell lymphoma

I have CLL/SLL lymphoma

I have Burkitt's lymphoma

I have Waldenstrom's Macroglobulinemia lymphoma

I have Transformed lymphoma

I have Peripheral T-Cell lymphoma

I have Cutaneous T-Cell lymphoma

I have NK-Cell lymphoma

I know someone who has lymphoma

I do not know what kind of lymphoma I have

I have another type of lymphoma, not listed here

Question Title

* 3. Will you be bringing a guest?

Yes

Not Sure