Request for a Professional Account

Please complete the forms below to request access to the LUNG CANCER REGISTRY.


User Information


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* 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
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Contact Information


* 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>
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Nature of Request


To request access to de-identified data* within the Lung Cancer Registry please indicate the specific question or areas of information you are interested in addressing with the Lung Cancer Registry data.

If you would like to submit a proposal for a research study to be conducted with the Lung Cancer Registry – please see the FAQ for further information on submission.



Permission

In applying for access to The Lung Cancer Registry Professional Portal, you must agree to the following:

  • If approved, your username and password should be used ethically and responsibly, only for yourself and those in your organization with similar intent
  • If you wish to publically share an analysis of the information included in The Lung Cancer Registry, you will ensure that the information is being used in an ethical manner and notify The Lung Cancer Registry of the data you plan to share to help us track outcomes. Publically published findings should credit The Lung Cancer Registry.
  • The Lung Cancer Registry will communicate outcomes from The Lung Cancer Registry data back to registered patient users.
  • The Lung Cancer Registry cannot be held accountable for the accuracy of information provided by users.



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The Lung Cancer Registry is sponsored by: