Florida Comprehensive Cancer Collaborative Member Profile 2015

Welcome! We value your interest and willingness to make a difference in your local cancer community.

Completing a Member Profile will take about 5 minutes and will better facilitate your involvement in the Regional Cancer Control Collaborative.

There is no cost for membership and no information will be shared with a third party.

Question Title

1. Please provide the following information:

Question Title

2. Please select which of the following sectors best represents you or your organization:

Question Title

3. Please select which of the following role or title best describes you:

Question Title

5. Please select your gender:

Question Title

6. Please select your race:

Question Title

7. Please select your ethnicity:

Question Title

8. Please select your highest level of education:

Question Title

9. Please select your age range:

Question Title

10. Please indicate your area(s) of interest and expertise:

  Interest Expertise
Training ideas and speakers
Breast cancer screening
Cervical cancer screening
Colorectal cancer screening
Data and evaluation
Disparities
Early detection efforts
Education
Epidemiology
Florida Cancer Plan
Genetics
Healthy weight
Human Papilloma Virus (HPV)
Lung cancer screening
Native American Indian
Palliative care
Policy and advocacy
Prevention efforts
Sun safety
Survivorship
Tobacco

Question Title

11. Each regional collaborative has different committees and workgroups.

Please select the committee you are interested in joining. The chairperson or local coordinator will contact you.

T