Membership Application Form

Membership Application Form
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MEMBERS' AREA

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

A function of the Members Database is to act as a search tool to assist members identify potential collaborators or expertise, and allow contact to be made.

If you do not wish to participate in this service, simply tick the box and your form will not be available for viewing.

YOUR DETAILS

Title*

First Name*

Last Name*

Position*

Institution*

Department*

Suburb*

State

Postal Code*

Region*

Country*

Email*

Phone Number

Mobile

Fax

* Compulsory fields

YOUR POSITION

Academic Social Worker Health Care Manager GP Psychologist Researcher - Clinical Physiotherapist Nurse Researcher - Health Services Occupational Therapist Program Or Policy Role Researcher - Epidemiology

Other medical position

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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