Patient involvement in EORTC Breast Cancer Group

Dear patient partner,

If you would like to express your interest and contribute your ideas to the EORTC Breast Cancer Group research, please complete the form below.

Thank you very much!

Sincerely yours,

Iryna

EORTC Patient Relationship Manager

iryna.shakhnenko@eortc.org

Question Title

* 1. Your title

Mrs

Question Title

* 2. Your name and last name

Question Title

* 3. Country of residence

Question Title

* 4. E-mail address

Question Title

* 5. Have you ever been affected by cancer, either directly or through someone close to you?

Yes

Other (please specify)

Question Title

* 6. Are you familiar with the clinical trial / research process?

Yes

Other (please specify)

Question Title

* 7. Do you represent or are affiliated with any patient organisation?

Yes (please specify)

Question Title

* 8. Your comments, questions, or suggestions

Question Title

* 9. I hereby give my consent for the processing of my personal data for the purpose of participating in the patient involvement activities of EORTC.
Our privacy policy: https://www.eortc.org/privacy-policy/

Yes

Patient involvement in EORTC Breast Cancer Group

Question Title

* 1. Your title

Question Title

* 2. Your name and last name

Question Title

* 3. Country of residence

Question Title

* 4. E-mail address

Question Title

* 5. Have you ever been affected by cancer, either directly or through someone close to you?

Question Title

* 6. Are you familiar with the clinical trial / research process?

Question Title

* 7. Do you represent or are affiliated with any patient organisation?

Question Title

* 8. Your comments, questions, or suggestions

Question Title

* 9. I hereby give my consent for the processing of my personal data for the purpose of participating in the patient involvement activities of EORTC.Our privacy policy: https://www.eortc.org/privacy-policy/

* 9. I hereby give my consent for the processing of my personal data for the purpose of participating in the patient involvement activities of EORTC.
Our privacy policy: https://www.eortc.org/privacy-policy/