Patient involvement in EORTC Head & Neck Cancer Group

Dear patient partner,

If you would like to express your interest and contribute your ideas to the research conducted by the EORTC Head & Neck Cancer 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

Mrs

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* 2. Your name and last name

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* 3. Country of residence

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* 4. E-mail address

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* 5. Have you had any personal experience of clinical trials or cancer research projects?

Yes

Other (please specify)

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

Yes

Other (please specify)

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

Yes (please specify)

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* 8. Your comments, questions, or suggestions

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* 9. I hereby give EORTC my consent to process my personal data for the purpose of participation in the activities of the EORTC Group of Patient Partners.
Our privacy policy: https://www.eortc.org/privacy-policy/

Yes

Patient involvement in EORTC Head & Neck 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 had any personal experience of clinical trials or cancer research projects?

Question Title

* 6. Are you familiar with the clinical trial 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 EORTC my consent to process my personal data for the purpose of participation in the activities of the EORTC Group of Patient Partners.Our privacy policy: https://www.eortc.org/privacy-policy/

* 9. I hereby give EORTC my consent to process my personal data for the purpose of participation in the activities of the EORTC Group of Patient Partners.
Our privacy policy: https://www.eortc.org/privacy-policy/