Registration Form

This form is used to pre-register anyone interested in participating in the Puipui Malu Manatu research program. This program aims to increase awareness about brain health. You must be 50 years or above, of Samoan ancestry, can speak Samoan or English, and agree to provide a blood sample. After pre-registering, the AS Community Cancer Coalition will contact you if selected to participate in the study. For further information or questions, please contact our offices at 272-5833 or 272-5374. Thank you!  
 
O le pepa resitara lenei mo i latou uma o lo’o fia auai i su’esu’ega o le porokalama o le Puipui Malu Manatu. O se porokalama e faatautaia suesuega aua le soifua maloloina o le mafaufau. O e e fia auai, e tatau ona 50 aga’i i luga tausaga o lou soifua, e te tupuga mai i tuaa Samoa, e iloa tautala ma e malamalama i le gagana fa’aSamoa po o le fa’aperetania, ma e malie e tui le toto mo su’esu’ega i se taimi o i luma. Afai e filifilia oe mo lenei suesuega, o le a faafesootai atu le Ofisa i se taimi o i luma. Mo ni fesili, faamolemole fa’afesootai mai le Ofisa o le Kanesa i le 272-5833, po’o le 272-5374. Faafetai ma ia manuia.  
 
 
 
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50% of survey complete.

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