Patient Panel Application

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Participation requires review of the chapter being discussed and submitting five questions 15 days prior to the production. The expected time commitment for each session you participate in is 2-3 hours. Are you able and willing to participate?
*

Learn From the Experts videos will be displayed on YouTube, social media channels and Caring Ambassadors websites. Only first names will be used during the patient panel session.

Yes, I agree to participate

Are you comfortable participating in a conversation about your personal experiences with lung cancer in an online group setting? *

Yes

Participants will be required to log on from their computers (no travel will be required). Do you have access to a private computer, webcam, and a reliable internet connection? *

Yes

Have you been diagnosed with lung cancer? *

Yes

Are you a patient or a caregiver ? *

Patient

Caregiver

Are you willing to participate in more than one video? *

Chosen participants will be paid $100 honoraria per completed video.

Yes

Full Name *

Email *

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