Registration
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About the Registry

Who will have access to my information?

Only trained registry managers will have access to your contact information. Your identity, such as your name or email address, is NEVER shared unless you request that it be shared. You can set your sharing preferences for each survey that you decide to complete.

How will my identity be protected?

All personal identifiers, such as your name or email address, are removed before your information is shared unless you ask us to disclose your contact information.

Who should I contact if I have any questions?

If you have questions that are not answered on this page, please explore the Frequently Asked Questions or Contact Us.


Account Registration

Addario Lung Cancer Registry collects health information in a way that protects your privacy and allows you to control access to your information. To register, you must meet one of the following:

  • Have a lung cancer diagnosis, be age 18 or older and be able to make your own medical decisions
  • Represent a child or dependent who has a lung cancer diagnosis and for whom you can legally make medical decisions
  • Is a caregiver for a person who has a lung cancer diagnosis
  • Represents someone who had a lung cancer diagnosis and is deceased

Account Holder

The person entering the data. This could be the person diagnosed with lung cancer if entering the data for oneself, or a caregiver/representative of a person diagnosed with lung cancer.


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* This Field is required Information for: Your Relationship to Participant : <p>Please tell us how you are related to the participant.</p>
* This Field is required Information for: Email : Please enter a valid e-mail address. A confirmation email will be sent to this address upon registration.
* This Field is required Information for: Confirm Email : <p>Please confirm your email address by entering it again.</p>
* This Field is required Information for: Username : Please enter a valid username.  No spaces, at least 3 characters and contain 0-9,a-z,A-Z
* This Field is required Information for: Password : Please enter a valid password.  No spaces, at least 8 characters and contain at least 1 lower-case letter, 1 upper-case letter, 1 number, and 1 symbol character
* This Field is required Information for: Re-enter Password : Please enter a valid password.  No spaces, at least 8 characters and contain at least 1 lower-case letter, 1 upper-case letter, 1 number, and 1 symbol character

Permission

By clicking the box, you agree to participate. If you change your mind and wish to stop participating, you are free to do so without having to provide any explanation. You also agree to the terms and conditions and privacy policy.

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Please enter the code below in all lowercase letters to confirm your registration. Phones and tablets may default the first letter to uppercase, only lowercase letters are accepted.

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The Lung Cancer Registry is sponsored by: