800-616-8347


FHCRC Homepage

  How to Participate in the NWCGN


You can take part in this national research effort by enrolling in the Northwest Cancer Genetics Registry. To be eligible for enrollment, you must live in Alaska, Idaho, Montana, Oregon, or Washington State. There are three ways to enroll.
  1. Online Contact Form: Complete the brief online form below, which indicates an interest in enrolling in the registry or in finding out more about the project. This online form requires only that you fill in some basic contact information so that we may call you. When you submit this form, your contact information will be sent to a project staff person who will mail you some introductory information and call you back by phone at a convenient time to describe the registry, confirm your eligibility and, if you wish, to conduct a more detailed enrollment questionnaire about your medical and family history. Only after completing this longer phone interview will you be enrolled in the registry.

    Please be aware that your contact information will be sent from this page to us by e-mail. Use of this website does not insure confidentiality nor privacy. If you are uncomfortable sending your name or phone number to us by e-mail, please contact us by telephone or mail (see below).

  2. Telephone: If you prefer to speak to someone in person to find out more or to enroll, you may call the NW Cancer Genetics Network at 1-800-616-8347. If the line is busy, you may leave a message on the voice mail so that a project staff person may return your call. Please include your name, phone number and convenient times for us to call you. If you need more general information about cancer and genetics you may call the Cancer Information Service at 1-800-4-CANCER.

  3. Mail: If you prefer to contact us by mail, you may print a specially formatted version of the online contact form below, directly from this page. You may open and print this document, complete it and mail it to us at the address indicated. A project specialist will contact you at a convenient time to go over the information you send us, and to confirm that you are both willing and eligible to participate. You will not be enrolled in the registry until a project specialist has spoken to you by phone and you have completed the survey.

uparrow.gif - 1197 BytesOnline Contact Form:
To express interest in enrolling in the Pacific NW Cancer Genetics Registry, please complete the form below. Questions marked with a red asterisk * must be must be completed before you can successfully submit the form. These items are required by the NWCGN staff in order to determine your eligibility, or to contact you by mail or telephone.
 

Your Name *:

Your Gender *

Male Female
Contact Address*:
Town/City *:
State *:
Zip Code *:
Daytime Phone Number:
Evening Phone Number *:
Best times to call you:
Example: M-F, after 5pm. (See below for our calling out times).
E-Mail Address:
Today's Date:
How did you hear about
the NWCGN or this website?:

If you have completed all the questions above, please click this button to send your contact details to us

Telephone:

uparrow.gif - 1197 BytesYou may prefer to speak to someone in person to find out more or to enroll.

To enroll by phone, or to find out more about the NWCGN project, you may call the NW Cancer Genetics Network at 1-800-616-8347.

If the line is busy, you may leave a message on the voice mail so that a project staff person may return your call. Please include your name, phone number and convenient times for us to call you.

We are available to call you at the following times (PST):
clock.gif - 157 Bytes Day Time
phone3.gif - 1141 Bytes Monday-Thursday: 9am - 9pm
phone3.gif - 1141 Bytes Friday: 9am - 5pm
phone3.gif - 1141 Bytes Saturday: 10am - 5pm
phone3.gif - 1141 Bytes Sunday: 2:30pm - 8:30pm

If you need more general information about cancer and genetics you may call the Cancer Information Service at 1-800-4-CANCER at at any time during working hours.

uparrow.gif - 1197 Bytes

Mail:

If you prefer to contact us by mail, you may print and send us a paper version of the online contact form by opening and printing the contact form web page. A project specialist will contact you at a convenient time to go over the information you send us, and to confirm that you are both willing and eligible to participate. You will not be enrolled in the registry until a project specialist has spoken to you by phone and you have complete the survey. Please be sure to answer every question before mailing either form.

Open Printable Contact Form Web Page

If you have the appropriate software, you can open and print the contact form in "Acrobat PDF" format.

To view and print these documents, you will need a copy of Adobe Acrobat Reader software, available without charge from Adobe Systems Incorporated (download from here) .



uparrow.gif - 1197 Bytes