9269 ASTCT - NMDP ACCESS Initiative Interest Survey

ASTCT - NMDP ACCESS Initiative Interest Survey

Please complete the form below providing your contact information and areas of interest as it pertains to the ASTCT/NMDP Joint ACCESS Initiative.

Contact Information *This question is required.

First Name

Last Name

Organization

Email Address

Cell Phone

Please indicate your preferred method of contact *This question is required.

Professional Job Title *This question is required.

Indicate the committee you are interested in joining. *This question is required.

a. Poverty (addressing the financial barriers to care)
b. Racial Inequity (addresses the racial barrier in place that impact care)
c. Awareness (addresses the lack of knowledge in regard to receiving a transplant)

Please use the space below for ideas for contribution and feedback regarding the ACCESS initiative