Lung Cancer Connect Webinar Registration If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. First Name * Last Name * Email * Post Code Gender please select male female Age please select 0-19 20-29 30-39 40-49 50-59 60-69 70-79 80+ What best describes you? please select Person with lung cancer diagnosis currently undergoing treatment Person with lung cancer diagnosis who has finished treatment Carer of someone with lung cancer Health Professional Other (Please Specify) Other What type of lung cancer do you or the person you care for have? please select please select an answer Lung cancer Non - small cell lung cancer Adenocarcinoma Squamous cell carcinoma Large cell carcinoma EGFR positive ALK positive Ros1 Small Cell Lung cancer Mesothelioma N/A How did you hear about this webinar? please select Email from Lung Foundation Australia Lung Foundation Australia’s social media Lung Cancer Network Australia’s social media From Lung Foundation Australia’s Information and Support Centre From Lung Foundation Australia’s Lung Cancer Care nurse From a health professional Word of Mouth Poster or Flyer Lung Foundation Australia Website Lung Cancer Network Australia Website From a Support Group Is there a question or topic you would like to see discussed? Would you like to join up to our free email patient newsletter, to be kept up to date with the latest news, information or events related to Lung Cancer? please select Yes No What is 1 + 4? (write your as a number) * The Lung Cancer Connect project is a Cancer Australia Supporting people with cancer Grant initiative, funded by the Australian Government.