International Gynecologic Cancer Advocacy Network - Interest Form

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* 1. What is the full name of your organization?

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* 2. If your organization is also referred to with an acronym, enter it here.

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* 3. Enter the website URL of your organization.

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* 4. Please enter the mission statement or purpose of your organization.

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* 5. Please check all the options you are interested in:

Being listed as part of the IGCANetwork on the IGCS website

Creating a profile on the IGCANetwork Patient Advocate Group Directory (currently in development to be launched towards the end of 2024)

Being listed as a Uterine Cancer Awareness Month Campaign Partner

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* 6. If you selected that you would like to be listed on the IGCS website as a IGCANetwork member or UCAM campaign partner, please upload a high quality image of your organization's logo.

PNG, JPG, JPEG file types only.

Choose File

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* 7. Who is the primary organizational contact?

Full Name

Role/Title

Email Address

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* 8. Please enter the email addresses of any additional contacts or representatives of your organization/group who should be included in IGCS-IGCAN communications related to Uterine Cancer Awareness Month Campaign Partner activities. (optional)

We recommend that all contacts also join the IGCS as a member or advocate member, which creates an account in our database. This ensures you will receive our emails to stay up to date with our activities and offerings. Sign up here: https://bit.ly/guesadvo

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* 9. What best describes your organization? Please be aware that we are only listing patient advocacy organizations on our website as network and campaign partners at this time.

Patient Advocacy and/or Support

Foundation or Trust

Clinical Trials/Research Group

Professional Medical Society

Pharmaceutical or Biomedical Technology

Other (please specify)

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* 10. What best describes those who subscribe to your organization's email list and follows your social media accounts? Check all that apply.

Cancer Patients and Survivors

Patient Advocates

Family Members and Caregivers

Physicians (Cancer Specialists)

Physicians (OB/GYN)

General Physicians

Researchers and Scientists

Industry

List any other options and please clarify which of the above choices the majority of your subscribers/followers are.

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* 11. Enter your social media handles (or paste in the URLs) so IGCS and IGCANetwork accounts can follow back your accounts and see your awareness campaign posts. We will make efforts to share and comment on your posts for Uterine Cancer Awareness Month.

X (Twitter)

Instagram

Facebook

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* 12. How do you plan to recognize Uterine Cancer Awareness Month? What sort of activities or communications are you planning?

Please be aware that IGCS Staff will review your organization's website and social media accounts prior to granting approval to being listed on the IGCS website as at part of the IGCANetwork and Uterine Cancer Awareness Month Campaign Partner.

Thank you for your support and for all that you do to raise awareness and provide much needed support and services to those affected by uterine and gynecologic cancers.