LAA Online Support Group Membership Form

Lymphoedema Association Australia Online Support Group

A form to be completed to become a member of the Lymphoedema Association Australia Online Support Group

Name

Address

Address 2

City/Town/Region

State

Post Code

Country

Email Address

Phone Number

By email

By phone

No preference

Word of mouth

Facebook

Instagram

Node News

LAA E-news

Other (please specify)

I have lymphoedema secondary to cancer, surgery, infection, or trauma

I have lymphoedema from a primary lymphatic disorder (birth, teenage years, midlife or aged spontaneous onset)

I have another form of lymphoedema

I am a carer for someone with lymphoedema

I am a lymphoedema health professional

I am a lymphoedema researcher

I work for a lymphoedema company

I am a member of Lymphoedema Association Australia

Do you have some other link to the lymphoedema community?

Yes, comfortable

Not comfortable, but know how to connect via Zoom

No, I need to learn how to use Zoom

Other (please specify)

Yes

Other (please specify)