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Global Virtual Cancer Conference - Nov. 13-14th 2020
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Global Virtual Cancer Conference - Nov. 13-14th 2020
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Jim Kelly
Benjamin Scheuer
Davide Piras
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Global Virtual Cancer Conference - Nov. 13-14th 2020 Registration Form
First Name
Last Name
Email
Gender
-- Please Select --
Female
Male
Transgender Female
Transgender Male
Genderqueer/Gender Non-conforming
Non-Binary
Prefer not to respond
When is your birthday? (Click date to select birthday faster)
Which of the following best describes you? (Please select all that apply)
*
Patient/Survivor
Caregiver
Family Member/Friend
Advocate
Healthcare Provider
Healthcare Industry
What type of cancer were you or a loved one diagnosed with?
-- Please Select --
Adrenal Cancer
Anal Cancer
Appendix Cancer
Bile Duct Cancer
Bladder Cancer
Bone Cancer
Bone Cancer (Chondrosarcoma)
Bone Cancer (Osteosarcoma)
Bone Cancer (Chordoma)
Bone Cancer (Ewing’s Sarcoma)
Brain Tumor
Brain Tumor (Astrocytoma)
Brain Tumor (Glioblastoma Multiforme)
Brain Tumor (Medulloblastoma)
Brain Tumor (Meningioma)
Brain Tumor (Glioma)
Breast Cancer (ER/PR +)
Breast Cancer (HER2 +)
Breast Cancer (Triple Negative)
Breast Cancer (Inflammatory)
Carcinoid Tumor
Cervical Cancer
Colorectal Cancer
Endometrial Cancer
Esophageal Cancer
Gallbladder Cancer
Gastrointestinal (Stromal Tumor)
Head & Neck Cancer
Hodgkin Lymphoma
Kidney Cancer (including Wilms Tumor)
Leukemia
Leukemia (ALL)
Leukemia (AML)
Leukemia (APL)
Leukemia (CLL)
Leukemia (CML)
Liver Cancer
Lung Cancer
Lung Cancer (NSCLC)
Lung Cancer (SCLC)
Lung Cancer (Mesothelioma)
Lymphoma
Melanoma
Multiple Myeloma
Myelodysplastic (MDS)/Myeloproliferative Neoplasms
Neuroblastoma
Neuroendocrine Tumor
Non-Hodgkin Lymphoma
Non-Hodgkin Lymphoma (DLBCL)
Non-Hodgkin Lymphoma (Follicular)
Non-Hodgkin Lymphoma (Marginal Zone)
Non-Hodgkin Lymphoma (Mantle Cell)
Ovarian Cancer
Pancreatic Cancer
Parathyroid Cancer
Penile Cancer
Pituitary Cancer
Primary Peritoneal Cancer
Prostate Cancer
Rectal Cancer
Retinoblastoma
Sarcoma
Sarcoma (Leiomyo-)
Sarcoma (Rhabdomyo-)
Sarcoma (Synovial)
Sarcoma (Kaposi)
Sarcoma (Nerve Sheath)
Skin Cancer
Skin Cancer (Melanoma)
Stomach Cancer
Testicular Cancer
Thyroid Cancer
Thyroid Cancer (Papillary)
Thyroid Cancer (Follicular)
Thyroid Cancer (Medullary)
Thyroid Cancer (Anaplastic)
Uterine Cancer
Vaginal Cancer
Vulvar Cancer
N/A
What is the stage of your cancer or the cancer of your loved one?
-- Please Select --
Stage 0: Abnormal cells are present that have the potential to become cancer.
Stage 1: The cancer is small and only in one area. Also known as localized or early-stage cancer.
Stage 2: The cancer is larger but has not spread.
Stage 3: The cancer is larger and has spread into nearby tissues or lymph nodes.
Stage 4: The cancer has spread to more distant parts of the body. Also known as advanced or metastatic cancer.
My cancer isn’t staged.
I don’t know.
N/A
If you selected Healthcare Professional
-- Please Select --
Nurse
Physician
Researcher
Social Worker
Mental Health Counselor
Pharmacist
Other Allied Health Professional
Other Allied Health Professional (please specify)
If you selected diagnosed/survivor, which best describes you?
-- Please Select --
Pre-Treatment
In Treatment
On-Going Therapies
Chronic Disease
Competed Treatment (<2 years ago)
Completed Treatment (>2 years ago)
Other Stage
Would you like to join The GRYT Project to receive notices about research studies (often compensated) for which you may be eligible?
-- Please Select --
Yes
No
Thank you for your interest in joining The GRYT Project. Please answer the following questions to help us determine projects in which you may be eligible to participate. By providing this information, you are not signing up for any specific project and your information will not be shared without your consent.
Where do you live?
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Other
Pakistan
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Vatican City State (holy See)
Venezuela
Vietnam
Western Sahara
Yemen
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Zambia
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When were you or a loved one diagnosed?
Additional cancer diagnosis
-- Please Select --
Adrenal Cancer
Anal Cancer
Appendix Cancer
Bile Duct Cancer
Bladder Cancer
Bone Cancer
Bone Cancer (Chondrosarcoma)
Bone Cancer (Osteosarcoma)
Bone Cancer (Chordoma)
Bone Cancer (Ewing’s Sarcoma)
Brain Tumor
Brain Tumor (Astrocytoma)
Brain Tumor (Glioblastoma Multiforme)
Brain Tumor (Medulloblastoma)
Brain Tumor (Meningioma)
Brain Tumor (Glioma)
Breast Cancer (ER/PR +)
Breast Cancer (HER2 +)
Breast Cancer (Triple Negative)
Breast Cancer (Inflammatory)
Carcinoid Tumor
Cervical Cancer
Colorectal Cancer
Endometrial Cancer
Esophageal Cancer
Gallbladder Cancer
Gastrointestinal (Stromal Tumor)
Head & Neck Cancer
Hodgkin Lymphoma
Kidney Cancer (including Wilms Tumor)
Leukemia
Leukemia (ALL)
Leukemia (AML)
Leukemia (APL)
Leukemia (CLL)
Leukemia (CML)
Liver Cancer
Lung Cancer
Lung Cancer (NSCLC)
Lung Cancer (SCLC)
Lung Cancer (Mesothelioma)
Lymphoma
Melanoma
Multiple Myeloma
Myelodysplastic (MDS)/Myeloproliferative Neoplasms
Neuroblastoma
Neuroendocrine Tumor
Non-Hodgkin Lymphoma
Non-Hodgkin Lymphoma (DLBCL)
Non-Hodgkin Lymphoma (Follicular)
Non-Hodgkin Lymphoma (Marginal Zone)
Non-Hodgkin Lymphoma (Mantle Cell)
Ovarian Cancer
Pancreatic Cancer
Parathyroid Cancer
Penile Cancer
Pituitary Cancer
Primary Peritoneal Cancer
Prostate Cancer
Rectal Cancer
Retinoblastoma
Sarcoma
Sarcoma (Leiomyo-)
Sarcoma (Rhabdomyo-)
Sarcoma (Synovial)
Sarcoma (Kaposi)
Sarcoma (Nerve Sheath)
Skin Cancer
Skin Cancer (Melanoma)
Stomach Cancer
Testicular Cancer
Thyroid Cancer
Thyroid Cancer (Papillary)
Thyroid Cancer (Follicular)
Thyroid Cancer (Medullary)
Thyroid Cancer (Anaplastic)
Uterine Cancer
Vaginal Cancer
Vulvar Cancer
Stage of additional cancer
-- Please Select --
Stage 0: Abnormal cells are present that have the potential to become cancer.
Stage 1: The cancer is small and only in one area. Also known as localized or early-stage cancer.
Stage 2: The cancer is larger but has not spread.
Stage 3: The cancer is larger and has spread into nearby tissues or lymph nodes.
Stage 4: The cancer has spread to more distant parts of the body. Also known as advanced or metastatic cancer.
My cancer isn’t staged.
I don’t know.
Date of additional cancer
If there is anything else you would like to share about your or a loved one's diagnosis, please share it here:
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contact@grythealth.com
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