You must have JavaScript enabled to use this form. Intro We want to hear from you. Our mission is to make Canada a better place to breathe in. You, Canadians with lung disease, can help us get to our goal. If you would like to be a patient volunteer, please fill out the form below. Starting in 2020 we will develop a plan to engage you. Please select any that apply: I would like to help with health information resources I would like to be trained as an ambassador, advocate and/or a spokesperson I would like to provide peer-to-peer support I would like to help in research grant selections Other : please specify Please select any that apply: Other: info prompt Please include the following information (mandatory): Name Province ProvinceAlberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Lung Disease Age Email Address Phone Number conclusion You will be contacted once an opportunity for a project arises. You may also be contacted in the interim for an opportunity to participate in a survey or a questionnaire. Even if you agree to be contacted, you reserve the right to refuse any particular project or survey. This is voluntary. Thank you! If you have any questions, please email info@lung.ca. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
