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HCP Register
Thank you for registering an interest in ALK Positive Lung Cancer (UK). Please provide your details and let us know how we can help you.
1.
Name.
2.
Job title.
3.
Place of Work.
4.
Address:
Address 1:
Address 2:
Address 3:
Address 4:
Post Code
5.
Email:
6.
Telephone:
7.
How can we help you?
Pleae keep me informed of latest devleopments in ALK-positive NSCLC.
Please send me leaflets and any other material which may be of interest to my ALK+ patients.
Please inform me of any activities, conferences, meetings or lunches, that may be of interrest to my patients.
Other (please specify)
8.
Do you consent to the Charity holding this information for the purpose of communicating with you?
Yes
No
9.
Thank you. Is there anything that you wish to add?