Membership Application

The following form will be used to gather information in order to process your membership application. Be sure to complete the entire form.

  • Membership Categories

    • Have a strong interest in reducing lung cancer morbidity and mortality
    • Have outstanding expertise and reputation in lung cancer information and research
    • Have a special expertise in lung cancer prevention, early detection and treatment
    • Can deliver lung cancer education
    • Can deliver lung cancer screening services
    • Can deliver smoking cessation/tobacco treatment services
  • CTRL + Click to select multiple task groups