SIOPE Survey 2016-2017

Contact Information

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1. Surname and Name:

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2. Country:

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3. Institition or Paediatric Haematology-Oncology Society/Group

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4. E-Mail:

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5. Profession

Paediatric Oncologist / Haematologist (please indicate your specialty in the field "Other")

Paediatrician

Oncologist

Paediatric Nurse

Psychologist - Psycho-social Support Specialist

Radiation Oncologist

Radiologist

Surgeon

Epidemiologist

Researcher / University Professor / Lecturer

Adult Oncologist / Haematologist

Parent / Patient / Survivor Advocate

Other (please specify)

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6. Age

18 - 29

30 - 44

45 - 59

60+

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7. Gender

Female

Male

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8. Are you member of SIOPE? (Required.)

Yes

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* 1. Surname and Name:

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* 2. Country:

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* 3. Institition or Paediatric Haematology-Oncology Society/Group

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* 4. E-Mail:

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* 5. Profession

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* 6. Age

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* 7. Gender

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* 8. Are you member of SIOPE? (Required.)

1. Surname and Name:

2. Country:

3. Institition or Paediatric Haematology-Oncology Society/Group

4. E-Mail:

5. Profession

6. Age

7. Gender

8. Are you member of SIOPE? (Required.)