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Living Well With Lymphoma - Montreal 2016
Thank you for taking the time to register for Living Well With Lymphoma - Montreal on November 19th with Dr. Kelly Davison, PhD, MDCM, FRCPC, McGill University Health Centre.
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Contact Information
(Required.)
Name:
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Address 1:
Address 2:
City/Town:
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State/Province:
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ZIP/Postal Code:
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Email Address:
Phone Number:
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What type of lymphoma were you diagnosed with?
(Required.)
Mantle Cell
Hodgkin
Follicular
DLBCL
T-Cell
CLL
SLL
Burkitt's
I don't have lymphoma
Other
Other (please specify)
If you have or had lymphoma, when were you diagnosed?
less than one year ago
1-2 years ago
2-3 years ago
4-5 years ago
5-10 years ago
10+ years ago
Which hospital were/are you treated at?
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How did you hear about this event?
(Required.)
Do you have any dietary restrictions? If yes, please explain
