Consumer Link Register

Membership Application Form
Consumer Link Register

MEMBERS' AREA

Personal identifiers

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Membership is free and open to all consumers with an interest in primary care cancer research.

The purpose of the Consumer Link Register is to facilitate consumer input into developing proposals or protocols for cancer research in primary care. A member of PC⁴ will contact us with their request, we will search our Register to match their request with your interest, and then contact you direct.

We do not provide your details to anyone else, and you are not committed to participate in any way or for any length of time. You can opt out at any time, either from our Register or any research project.

YOUR DETAILS

Title*

First Name*

Last Name*

Address 1*

Address 2

Suburb*

State

Postal Code*

Region*

Country*

Email*

Phone Number

Mobile

Fax

* Compulsory fields

YOUR RESEARCH INTEREST(S)

What are your area(s) of research interest? Tick as many as you like.

CANCER

Breast Prostate Bowel Lung Melanoma Lymphoma Gynaecological Urological Upper GI Leukaemia Brain All

Other Cancer

RESEARCH INTEREST

Prevention Screening Diagnosis Management Palliative Care All

Other research

OTHER MEMBERSHIP

AGITG - Australasian Gastrointestinal Trials Group ASSG - Australasian Sarcoma Study Group ALLG - Australian Leukaemia and Lymphoma Group ANZBCTG - Australia New Zealand Breast Cancer Trials Group ANZCHOG - Australia New Zealand Childrens Haematology and Oncology Group ANZGOG - Australia New Zealand Gynaecological Oncology Group ANZMTG - Australia New Zealand Melanoma Trials Group ANZUP - Australia New Zealand Urogenital and Prostate Cancer Trials Group COGNO - Co-operative Trial Group for Neuro-Oncology PoCoG - Psycho-oncology Cooperative Research Group TROG - TransTasman Radiation Oncology Group

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