Join the Registry


Registration
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Power Lung Cancer Research. Share Your Story.

No one knows more about lung cancer than you. Join the registry and have a direct impact on the future of lung cancer care. Sharing your lung cancer experience is quick and confidential.

You can sign up if you:

  • Have a lung cancer diagnosis, are age 18 or older, and are 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.
  • Are a caregiver for a person who has a lung cancer diagnosis.
  • Represent someone who had a lung cancer diagnosis and is deceased.

Sign Up

The account holder is the person entering the data. This could be the person diagnosed with lung cancer or a caregiver / representative. The patient, sometimes referred to as participant, is the person who has been diagnosed with lung cancer.


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* This Field is required Information for: What is your relationship to the patient? : <p>Please tell us how you are related to the patient.</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

Learn more about how we protect your privacy.

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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