Dear patient partner,

If you would like to express your interest and contribute your ideas to the research conducted by the EORTC Cutaneous Lymphoma Group, please complete the form below.
 
Thank you very much!
Sincerely yours,
Iryna 
 
EORTC Patient Relationship Manager
iryna.shakhnenko@eortc.org

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1. Your title (Required.)

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2. Your name and last name (Required.)

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3. Country of residence (Required.)

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4. E-mail address  (Required.)

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

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6. Are you familiar with the clinical trial / research process? (Required.)

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7. Do you represent or are affiliated with any patient organisation? (Required.)

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8. Your comments, questions, or suggestions

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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/ (Required.)

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