BISA Support & Volunteer Survey
We need support to achieve our goals of raising awareness and changing regulation and laws. How can you help? Here is a simple survey with a variety of ideas and options.
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Full Name: *
Email address: *
Would you like to receive our newsletter? *
Phone number (optional):
How did you hear about about us? *
What country do you live in? *
If you live in the US, please select your state:
Do you follow us on social media? Please check all that apply *
Required
Which social media do you currently use most often? Please check all that apply *
Required
Please select ways you might be able to help: *
Required
Do you volunteer or admin in any support groups? If so, please list the group.
Do you have any contacts to any representatives?
Please briefly share your experience with breast implants and why you would like to help:
Which best describes you? *
Required
Here are some ways you can help. Have you done any of the following? Please check all that apply
Did you experience breast cancer? *
We all have particular experience and talents to offer. Do you have particular background or passion that would be helpful? *
Do you have a business that might be able to help provide services?
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