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ASTCT - NMDP ACCESS Initiative Interest Survey
Please complete the form below providing your contact information and areas of interest as it pertains to the ASTCT/NMDP Joint ACCESS Initiative.
*
1.
Contact Information
(Required.)
Name
*
Organization
*
Email Address
*
Cell Phone Number
*
2.
Please indicate your preferred method of contact
(Required.)
Email
Cell Phone
*
3.
Professional Job Title
(Required.)
*
4.
Indicate the Committee you are interested in joining.
(Required.)
Poverty (addressing the financial barriers to care)
Racial Inequity (addresses the racial barrier in place that impact care)
Awareness (addresses the lack of knowledge in regards to reieving a transplant)
5.
Please use the space below for ideas for contribution and feedback regarding the ACCESS Initiative