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Southwestern Ontario Chapter Meeting - February 7, 2018

Understanding the Impact a Cancer Diagnosis has on both the Patient and the Caregiver.

Thank you for taking the time to register for the Southwestern Ontario Chapter Meeting on February 7, 2017: Understanding the Impact a Cancer Diagnosis has on both the Patient and the Caregiver.

*1.Contact Information(Required.)

First Name: *

Last Name:

City/Town:

ZIP/Postal Code: *

Email Address: *

Phone Number:

*2.Please indicate your interest in lymphoma (you may select all that apply).(Required.)

I have Hodgkin lymphoma

I have Follicular lymphoma

I have Diffuse Large B-Cell lymphoma

I have Marginal Zone/MALT lymphoma

I have Mantle Cell lymphoma

I have CLL/SLL lymphoma

I have Burkitt's lymphoma

I have Waldenstrom's Macroglobulinemia lymphoma

I have Transformed lymphoma

I have Peripheral T-Cell lymphoma

I have Cutaneous T-Cell lymphoma

I have NK-Cell lymphoma

I have another type of lymphoma, not listed here

I do not know what kind of lymphoma I have

I know someone who has lymphoma

Other

Other (please specify)

3.Will you be bringing a guest?

Yes

No

Not Sure

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