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Please complete the form below to have your details added to the Friend Finder listing so that other Hodgkin's patients and survivors can contact you directly. Please note that all the information you provide in this form will be included in your listing, with the exception of your last name. If you do not wish to disclose certain information, leave that field blank. If at any time you wish to change any of your details listed on the website, please email me.

Fields marked with an * are required.

*Last Name:

*I am a: Patient Survivor

Type of Hodgkin's Lymphoma:

*Date diagnosed:

Stage at diagnosis:

*Date of Birth:

*Male Female

My cancer treatment includes: Chemotherapy Radiation therapy

*City:

*State:

*Email address:

Telephone:

Website:

Interests:

Arts/Crafts
Astrology/New Age
Athletics
Baseball/Softball
Billiards/Pool/Darts
Boxing/Wrestling
Cars/Motorcycles
Computers/Internet
Cooking
Cricket
Cycling
Dancing
Food and Wine
Football/Soccer/Rugby
Gardening
Golf
Gym/Aerobics
Hiking/Camping
Ice/Snow Sports
Literature/History
Martial Arts
Motor Racing
Mountaineering
Movies/Cinema
Museums/Galleries
Nature
Nightclubs/Clubs
Politics
Religion
Sailing/Boating
Shopping
Singing/Playing Instrument
Tennis/Racket Sports
Theatre/Ballet
Travel/Sightseeing
Volleyball/Basketball
Volunteer/Charity
Water Sports
Yoga/Meditation
Musical Taste:
Alternative
Blues/Jazz
Christian/Gospel
Classical/Opera
Country
Dance/Electronic
Latin
New Age
Pop/R&B
Rock
World

What additional comments, experiences or ideas would you like to share?

How did you hear about the Australian Hodgkin's Lymphoma Network? Other:

*I have read and accept the privacy policy.