ALK Register

ALK Positive Lung Cancer (UK)

Thank you for asking to be added to the ALK Register which is only for patients with ALK-positive lung cancer, living in the UK and Ireland, and a close family member or friend.

Could you please complete this questionnaire. The personal information that you provide will be used (a) to inform you by email of the charity's activities, of developments concerning ALK-positive lung cancer and of opportunities to take part in research and (b) anonymously, to advance our advocacy and campaigns for early diagnosis and to raise awareness of lung cancer in non-smokers.

The charity's full Privacy Policy is available at our website at www.alkpositive.org.uk or by emailing hello@alkpositive.org.uk.

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* 1. Name

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* 2. email

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* 3. Telephone No.

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* 4. Address

Address

Address 2

City/Town

County *

Post Code

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* 5. I am

the patient

family member/friend