Guideline Volunteer Interest Form We are so pleased you are interested in participating in the ASCO Guidelines Program. Members can participate in a variety of ways. Please indicate your participation interests. DEMOGRAPHIC INFORMATION Question Title * 1. Please indicate your name and contact information Name: * Institution: * State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Country: Email Address: * Question Title * 2. Please note your professional role. Medical Oncology Radiation Oncology Surgical Oncology Patient Representative/Advocate Oncology Nurse Other (please specify) Question Title * 3. Please indicate how many years you have been in practice? 0-5 years 6-15 years > 15 years Question Title * 4. In what areas are you interested in volunteering? Evidence Based Medicine Committee (EBMC)-guideline review and approval body Guideline Advisory Groups (GAG)-topic prioritization body Guideline Expert Panels-develop guideline recommendations Question Title * 5. What diseases sites do you treat? Breast Cancer Gastrointestinal Cancers Genitourinary Cancers Gynecologic Cancers Head & Neck Cancers Hematologic Malignancies Lung Cancers Melanoma Neuro-oncology Sarcoma Other (please specify) Question Title * 6. Please indicate other topics in which you are interested. Geriatric Oncology Supportive Care & Treatment-Related Issues Patient and Survivor Care Molecular Testing and Biomarkers Global Oncology Other (please specify) Question Title * 7. ASCO you active in your state society or regional council? Yes No Question Title * 8. Please share any other questions or comments you have below: Please contact guidelines@asco.org if you have any questions or comments. If you'd like to submit a topic for guideline development, please visit https://svy.mk/1S4Ks6z Submit
