Registration Form (2)


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You have accepted the Members Agreement

Please complete the online application to register to become a Silver Buddy.

If you are under age 16, due to differing international law requirements regarding children’s online privacy, we are unable to collect personal information about you. Instead, please ask your parent or guardian to join on your behalf. Parents: Please enter your own contact information, we cannot collect information that identifies your child who is under age 16.

If you have registered but not received your verification email, click here to get the verification email again.

SECTION 1 The following information (in bold) must be completed. It will be available to people searching for a buddy on this website.
Chosen Username	The nickname that people will see for you The name must be 3 to 12 characters long Only letters, numbers and spaces are permitted.
Town/City
County/State
Country	If your country is not listed, please tell us
Gender
Age Range
How affected by cancer
Cancer Type	If your cancer does not fall into any of these categories, please tell us

First diagnosed with cancer	year - for example 2005

Still undergoing treatment?	Yes* No Deceased
* if Yes, check the appropriate boxes (optional)	Chemotherapy Surgery Radiotherapy Outpatient drugs, eg. Tamoxifen Other
if No or Deceased**, year of last treatment
The next information is optional and you do not have to complete it. However, it will help us and other buddies if you do provide information here. This information will be visible to registered persons searching for a buddy on this website.
Hobbies/Interests
About Yourself

How did you find us?
(please specify)

SECTION 2 *The following information (marked ) must be completed. It is kept private and is not disclosed to any buddy visiting or searching this website.**
* Title	(Mr, Mrs, Ms, Dr, etc)
* First/Given name
* Surname
* MAIN Email Address
It is vital that you use a working email address and that the account is not closed or the mailbox full. Please check your Junk/Trash/Spam folders for our emails if you don't hear from us straight away. If you do not get our verification message, you will be unable to complete your registration. Click here for email advice.

ALTERNATIVE email address
If you have one, please provide an alternative or additional email address. PLEASE DO NOT repeat your main email address here. With an alternative address, we can still contact you if your main email address fails for any reason.

SECTION 3 When you press the REGISTER button below, an email will be sent to you. It will contain your username, password and a website link. Please ensure that your email address is correct and the mailbox is not closed/full or you will not receive this email. When you have got the email, click the link inside it. You will be asked for your username and password to log into the site. Once you have logged on, you should change your password to another (more memorable) value.
Confirm MAIN Email Address

I agree to my CBN profile being searched by other buddies. (You must check this box)
I would be happy to receive occasional Newsletters about what's happening at CBN. (Please check this box if you are happy to receive these. This is optional)
We will not pass your details onto any third parties. You have already accepted the Cancer Buddies Network Membership Agreement. When you have clicked the link below, check your email for instructions on what to do next. You cannot log into the members area until you have read this email and verified your membership.