CML Advocates Network - CML Support Group Registration

CML Advocates Network

For Chronic Myeloid Leukemia Patient Group Advocates

Home

...add your group

Main Menu

CML Support Group Registration

Our main intent in the public area of the website is to provide a worldwide web directory of patient groups representing patients with CML and their relatives. The directory allows patients to find national support groups in another country.

In case your leukemia patient organisation is not yet listed in our web directory, we would very much appreciate if you can provide us with a brief profile of your organisation. After you fill in the following form, we will list your organisation on the CML Advocates Network as soon as possible!

Furthermore, if you have any questions how to fill out the form, please feel free to send us an email to info@cmladvocates.net!

Your First Name:

Your Family Name:

Your Organisation's name:

Postal address:

Country:

Telephone of organisation:

Fax of organisation:

Official E-Mail address of the organisation:

Website address:

Key contact (name of person, and his role in the organisation):

Brief description of your organisation:

Key objectives and key initiatives of your organisation:

Number of members, or patients you represent:

Required field