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NRG Oncology Participation Powers Research
First Name
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Last Name (Your last name will NOT be shared)
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Email Address
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Select the term that you would like to appear under your name. You can select up to 3 terms.
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Select the term that you would like to appear under your name. You can select up to 3 terms.
Patient
Survivor
Thriver
Previvor
Caregiver
Healthcare Professional
Researcher
Advocate
Other
If you selected 'Other' above, please list the term(s) below.
Contact Phone Number (In case we have questions)
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Social Media Handles (X/Facebook/Instagram/LinkedIn/BlueSky). If none, put N/A.
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If you have been treated for cancer, what type(s) were you treated for? If you are a caregiver, select N/A.
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If you have been treated for cancer, what type(s) were you treated for? If you are a caregiver, select N/A.
Breast
Lung
Prostate
Colorectal (Colon or Rectal)
Melanoma (Skin)
Bladder
Kidney
Pancreatic
Liver
Stomach (Gastric)
Ovarian
Cervical
Endometrial (Uterine)
Thyroid
Head and Neck
Brain / Central Nervous System
Leukemia
Lymphoma
Multiple Myeloma
Sarcoma
Other
N/A
If you selected 'Other' above, please list the type(s) below.
Have you or a loved one participated in a clinical trial?
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Have you or a loved one participated in a clinical trial?
Yes
No
Not Sure / Not Applicable
In 1 sentence, complete the answer to the following question "what's one milestone you were able to experience thanks to cancer research?" Please begin with..."Because of cancer research, I was...". If you are a caregiver, what's one milestone you and your loved one got to experience together thanks to cancer research? Please begin with "Because of cancer research, we..."
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In a paragraph or two, please share a longer version of how cancer research has impacted your or your loved one's life and helped you or your loved one experience moments and memories that may not have been possible otherwise. This is optional.
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Would you prefer your post use photo images you provide or a video recording of you sharing you or your loved one's milestone moment? If you prefer video, we will be in contact to help you with submitting your existing video OR we will help you prep a short script before recording your video and submitting it.
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Would you prefer your post use photo images you provide or a video recording of you sharing you or your loved one's milestone moment? If you prefer video, we will be in contact to help you with submitting your existing video OR we will help you prep a short script before recording your video and submitting it.
Image(s)
Video
Please upload a selection of up to 3 photos that, if possible, include a photo of at least one milestone moment you or your loved one got to experience as a result of benefitting from cancer research. Alternatively, you can email Communications@NRGOncology.org.
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Click to choose a file or drag here
Size limit: 10 MB
If you prefer to send a video, Please email Communications@NRGOncology.org.
Submit
