Living Well With Lymphoma - Montreal 2016

Thank you for taking the time to register for Living Well With Lymphoma - Montreal on November 19th with Dr. Kelly Davison, PhD, MDCM, FRCPC, McGill University Health Centre.

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* Contact Information

Name: *

Address 1:

Address 2:

City/Town: *

State/Province: *

ZIP/Postal Code: *

Email Address:

Phone Number:

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* What type of lymphoma were you diagnosed with?

Mantle Cell

Hodgkin

Follicular

DLBCL

T-Cell

CLL

SLL

Burkitt's

I don't have lymphoma

Other

Other (please specify)

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* If you have or had lymphoma, when were you diagnosed?

less than one year ago

1-2 years ago

2-3 years ago

4-5 years ago

5-10 years ago

10+ years ago

Living Well With Lymphoma - Montreal 2016

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* Contact Information

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* What type of lymphoma were you diagnosed with?

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* If you have or had lymphoma, when were you diagnosed?

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* Which hospital were/are you treated at?

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* How did you hear about this event?

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* Do you have any dietary restrictions? If yes, please explain