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Professional Member
Become a Professional Member
by registering using the form below:
First Name
Last Name
E-mail Address
Username
Password
Confirm Password
Organization:
How would you best describe your organization?
Community Nonprofit organization
National Non-profit organization
Government agency or office
Hospital / Hospital Health Clinic
Primary Care
Specialty Care
Non-medical
Other
Please select what role or title best describes you:
Community Health Worker
Health Administrator
Licensed Counselor
Navigator
Nurse
Nurse Practitioner / Physician Assistant
Oncologist / Physician
Physical Therapist / Occupational Therapist / SLP / Dietitian
Social Worker
Other
Please indicate your area of interest or expertise:
I am interested in giving and/or attending lectures or presentations as part of a health related speaker’s bureau
Health Disparities, Navigation, and Access to Healthcare
Hispanic or Migrant populations as they relate to cancer
Prevention & Early Detection Efforts (Tobacco Cessation, Healthy Living, Nutrition, etc.)
Florida Cancer Plan
Survivorship
HPV
Lung Cancer
Colon Cancer
Children with cancer or who are affected by a parent with cancer
I would like to volunteer to help the Cancer Alliance of Marion County with the following:
Membership
Communications
Speakers Bureau & Events
Organizing data
Only fill in if you are not human