Membership Form

  • 1. Please provide the following personal information:

    FULL = non-profit patient organisations with a sole or significant focus (demonstrated by clear evidence of existing activities) on the needs of CLL patients. // ASSOCIATE = non-profit patient organisations with a partial focus on the needs of CLL patients but do not have a dedicated CLL patient program. // SUPPORTER = individuals with an interest in CLL patient support and advocacy OR individuals strongly motivated to start CLL patient groups in their own countries.
  • The following questions pertain to organisations. If you are applying to become a Supporter, please go to question 11.
  • 7. Organisation's contact information:

  • 8. Key contact person at your organisation:

  • The following questions pertain to individuals. If you are applying as an organisation, please go to the end of the form.
  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.
  • Thank you for your application. It will be reviewed by the CLLAN Steering Committee at the next scheduled meeting. You will be contacted if there are questions about your application and informed of the decision on your membership once it has been made. If you have any questions, comments or concerns, please list them here or email us at info@CLLAdvocates.net.