Please let us know your preferences!
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Name:
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Email Address
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First Name
Last Name
Organization
Which Committee(s) are you interested in joining?
Primary Prevention
Secondary Prevention
Treatment and Diagnosis
Survivorship
Palliative Care
In which region(s) do you live or work?
Boston
Central MA
Metro West
Northeast
Southeast, Cape & Islands
Western MA
I do not reside in Massachusetts
Do you have expertise in the following areas?
Advocacy
Communication
Data & Evaluation
Strategic Planning & Implementation
Which sector(s) do you work with or identify with?
Cancer Patient/Survivor
Caregiver/Family Member
Faith-Based Organization
Community-Based Organization
Research/Academia
Hospital/Cancer Center
Primary Care Provider
Community Member
What is your race? Choose all that apply.
American Indian or Alaska Native
Asian
Black or African American
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Other
Not sure
Prefer not to answer
Are you Hispanic/Latinx?
Yes
No
Which best describes your sexual orientation?
Asexual
Bisexual and/or pansexual
Lesbian or gay
Heterosexual (straight)
Queer
Questioning/I am not sure of my sexuality
I don’t understand what this question is asking
Other
I prefer not to answer
Which best describes your gender identity?
Male; man; boy
Female; woman; girl
Not exclusively male or female, nonbinary, and/or something additional
I am questioning/not sure of my gender identity
I don’t understand what this question is asking
I prefer not to answer
Are you transgender or of transgender experience?
Yes
No
I am questioning/not sure
I don’t understand what this question is asking
I prefer not to answer
