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LAA Online Support Group Membership Form
Lymphoedema Association Australia Online Support Group
A form to be completed to become a member of the Lymphoedema Association Australia Online Support Group
1.
Please complete the following details
Name
Address
Address 2
City/Town/Region
State
Post Code
Country
Email Address
Phone Number
2.
What is your preferred way of contact?
By email
By phone
No preference
3.
How did you hear about this group?
Word of mouth
Email
Facebook
Instagram
LinkedIn
Node News
LAA E-news
Other (please specify)
4.
Which of the following apply to you?
I have lymphoedema secondary to cancer, surgery, infection, or trauma
I have lymphoedema from a primary lymphatic disorder (birth, teenage years, midlife or aged spontaneous onset)
I have another form of lymphoedema
I am a carer for someone with lymphoedema
I am a lymphoedema health professional
I am a lymphoedema researcher
I work for a lymphoedema company
I am a member of Lymphoedema Association Australia
Do you have some other link to the lymphoedema community?
5.
Are you comfortable using Zoom technology for online meetings?
Yes, comfortable
Not comfortable, but know how to connect via Zoom
No, I need to learn how to use Zoom
Other (please specify)
6.
Do you agree to the following group rules?
Be kind
Listen closely
Have patience
Don't judge
Show respect
Keep what you hear in the group private
Different people have different journeys; all are important and can be learned from
Speak up for peer power
Give time to hear from all
Contact your leaders if you have any concerns from the meetings
Yes
No
Other (please specify)