CBCRP Advocate Registration

Questions marked with a * are required

Thank you for your interest in keeping California's breast cancer research relevant to those affected. This registration is for residents of the state of California interested in working with scientists on studies funded by the California Breast Cancer Research Program (CBCRP). You can find more information about advocate and community representative involvement in our research projects here. Most people should be able to fill this form out in about 30 minutes, but some may want to look up information about past training or research experience. Please note that although some people who sign up in this advocate registration have had training and experience, we don't expect everyone to have had training and experience. If you have any questions or concerns, please call us at 888-313-2277 or email us at getinfo@CABreastCancer.org.

1. Overview

By filling out this form, I agree to be part of a confidential database of California-based breast cancer and health advocates and community representatives interested in collaborating on breast cancer research projects. I understand that I will receive periodic emails about CBCRP and its programs.

I consent to the following:
• CBCRP staff may use my responses about the region of California in which I live, my interests, my background and my experience to identify possible researcher collaborators; and
• CBCRP staff may share my contact information with individual California scientists who seek advocate input on a research project.

I understand that responding to this survey does not obligate me in any way to participate in a CBCRP-sponsored research project.

I agree