Southwestern Ontario Chapter Meeting - August 7, 2019

Self-Care for Patients and Care Partners

Thank you for taking the time to register for the Southwestern Ontario Chapter Meeting on August 7, 2019:

Self-Care for Patients and Care Partners

First Name: *

Last Name:

City/Town:

ZIP/Postal Code: *

Email Address: *

Phone Number:

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 have another type of lymphoma, not listed here

I do not know what kind of lymphoma I have

I know someone who has lymphoma

Other

Other (please specify)

Yes

Not Sure