UAB Health System | Cancer Answers Membership Registration

UAB Cancer Answers Membership Registration

Whether you want to prevent cancer, learn about the best detection methods and treatments, offer support to a loved one, or get the most out of life as a cancer survivor, the UAB Cancer Answers program can help. A comprehensive program designed for people of all ages, Cancer Answers gives you the important information you need to lead a healthier life. To enroll, please complete the membership form: Required fields are marked with * below.
Salutation:	Mr. Ms. Mrs. Miss
First Name: *
Last Name: *
Address: *

City: *
State: *
ZIP Code: *
Gender: *
Date of Birth: *

E-mail Address:
Email Format:	Text / Don't Know HTML
I would like to receive a health e-newsletter via e-mail:	Yes No

Are you a UAB Health System Employee?	Yes No
If yes, which facility?
Are you currently a patient of the UAB Health System?	Yes No
I am interested in the following topics:
Conditions Blood Cancer (includes Leukemia, Myeloma, and Lymphoma) Bone Cancer Breast Cancer Gastrointestinal Cancer Colorectal Cancer Esophageal Cancer Liver Cancer Pancreatic Cancer Stomach Cancer Gynecological Cancer Cervical Cancer Ovarian Cancer Uterine Cancer Head / Neck Cancer	Lung Cancer Neurological Cancer (includes Brain Cancer) Prostate Cancer Skin Cancer Urologic Cancer (includes Bladder Cancer) Lifestyle Issues Exercise Nutrition Smoking Stress Other Cancers: (Indicate Form(s) of Cancer.)
Other Procedures / Programs Breast Cancer Prevention and Risk Assessment Clinic Cancer Genetics Clinic Cancer Resource Library Clinical Trials / Research Studies Donation / Volunteer Opportunities Gamma Knife Program Ovarian Cancer Prevention Clinic Palliative Care / Supportive Care Reconstructive Surgery Support Groups: (Indicate Type(s) of Cancer.)

This offer valid with respect to individuals interested in the Cancer Answers program as determined in the UAB Health System's sole discretion. Privacy Policy and Use of Personal Information: All personal information you provide to the UAB Health System Web Site is kept confidential. The Health System will not sell, rent, or release your name, e-mail address or other personal information you provide. The personal information you provide will be used to better understand the interests and opinions of groups or segments of people within the healthcare market and enable the Health System to provide you with current healthcare information based on your interests.

UAB Health System