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LBCA Advocate Registry
The Lobular Breast Cancer Alliance (LBCA) is seeking to build a registry of ILC advocates for two reasons. You can indicate whether you would like to be included for one or both of these reasons below.

Reason #1: Connecting Trained Advocates with Researchers
Many funding solicitations, including those issued by LBCA, include a requirement for scientists to engage research advocates in the application and grant implementation processes. LBCA anticipates that we may be contacted by researchers seeking patient advocates with experience and/or training in research advocacy. Our aim is to be ready with a list of contacts, with appropriate information about training and experience, so that we can share a name, contact information, and past experience with those researchers. At this point, LBCA will not be matching scientists to research advocates but would rather provide the list (either in its entirety or with selected advocates based on need and/or geography) to the researcher. They would then reach out to advocates directly.

Reason #2: Connecting with Others in Your Geographic Area to Raise Awareness about ILC
Are you someone who would like to find others near you to connect with and to figure out ways you might spread the word about ILC together? For example, you might be treated at the same facility and together can approach the breast cancer oncologists to share information about ILC and LBCA as a resource for patients. There is strength in numbers when initiating contact with your local research institutions and/or patient advocate groups. If you would like us to share your contact information with other patient advocates in your area (state or region of a non-US country and region) seeking to make a connection, please add your name and preferred method of contact below.

Please note: There are many resources for patients to be connected to trained peer mentors for support, including others with ILC. These organizations can be found here: https://lobularbreastcancer.org/find-support/.
 
The intent of this advocate registry is to connect with others who are considering ways to advocate for ILC research and raise awareness about ILC locally.

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**LBCA will not use or share the information provided in this form for any purpose other than the two listed below without your permission.**
 
Three additional questions are included at the end of the form for LBCA internal purposes only. This information will not be included as part of the registry information.  

To learn more about research advocacy training, see: https://lobularbreastcancer.org/advocacy-toolkit/.
To learn more about additional volunteer opportunities with LBCA, see: https://lobularbreastcancer.org/volunteer/

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I am interested in being part of the LBCA research advocate registry for the following purpose: (Please select all that apply) *
Required
First Name: *
Last Name: *
Location (City & State, or City/Region & Country (if outside of US)): *
Please indicate your preferred method of communication: *
Email Address:
Phone Number:
Please indicate your relationship to ILC: *
Related to Reason #1: Please indicate which research advocacy training programs you have completed: (Select all that apply)
Related to Reason #1: Please indicate any organizations with which you have been a past research grant application reviewer: (Select all that apply)
Related to Reason #2 (optional): If you know the research institution or the type of educational activity you are interested in engaging with/in locally, please note this below. This may help in matching interests of those locally.
Are you interested in joining an LBCA Satellite Advocacy Group or forming one if one does not exist in your area?
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FOR INTERNAL USE: If you have experience in reviewing research grant applications as a patient research advocate, would you be willing to mentor research advocates that have less experience or are just starting out?
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FOR INTERNAL USE: Would you be interested in assisting LBCA review grant applications in the future?
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FOR INTERNAL USE: If you are not already on LBCA's "Advocate Email List" where LBCA shares advocacy and educational opportunities via email, would you like to be added to this list? (Emails are sent approximately 1-2 times per month)
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