Action on Bladder Cancer: Register

Register with Action on bladder cancer

ABC is a Charity that works with healthcare professionals, patients, their carers and the general public, to help improve the care of people with bladder cancer through awareness raising, education and research projects. Please register with ABC and help us achieve our aims.

Title:	First name:
Middle initials:	Surname:
Date of Birth:	Sex:	Male: Female:
Address:	Phone:
	Mobile:
Postcode:	Email:
Please answer where applicable:	Where did you hear about ABC?
I am a member of a voluntary group/charity	From someone already linked to ABC A letter from ABC An email from ABC Poster/leaflet In the press, radio, internet or other media From my doctor, nurse or other carer Friend/colleague Other (please specify below)
Name of Group:
Number:
I work for another type of organisation
Name of organisation:
Role:
I am a healthcare professional
Profession:
Field:	I would like to support ABC in the following ways:
HCP special interest	Local campaigning Regional campaigning Fundraising Spokesperson None of the above
Area of Specialist Interest in bladder cancer:
Please select whether you would like to sign up for our information and whether you would be happy for us to contact you in the future. Please note that your personal information is confidential to ABC. I would like to subscribe to ABC mailings and other information I am happy for ABC to contact me about its work via email I do not wish to receive further information about the ABC’s work
This section is just for those affected personally by bladder cancer
I have been diagnosed with bladder cancer:	Yes: No:
The current status of my condition is:	Newly diagnosed/undergoing assessment Undergoing treatment In remission All clear
A friend or family member has been diagnosed with bladder cancer	Yes No Possibly