Wear it pink this October At work. At school. At home. Wherever you do it, wear pink and raise money to fund life-changing research and support
Home Get involved Volunteer with us Become a patient representative Thank you for your interest in becoming a patient representative. About you First name * Last name * Email * Phone number * Why do you want to get involved in the Service Pledge? This is so we can learn a bit more about you and reasons for your interest. Next steps The next step will be a phone call with a member of the Service Pledge team from Breast Cancer Now where we can find out more about you and you can ask any questions you may have about the patient representative role. This will help you and Breast Cancer Now decide if this role is suitable for you. To help us ensure we arrange this call at a time convenient for you, please specify any preferences you have for days of the week and/or times of day for us to call you. Preferred days for phone interview Preferred days for phone interview Monday Tuesday Wednesday Thursday Friday Preferred time for phone interview Preferred time for phone interview Morning 9.30am - 12 noon Afternoon 1pm - 4.30pm How we use your information We will use the information which you provide on this form to select patient representatives for the Service Pledge for Breast Cancer and (if you become a patient representative) to manage our relationship with you sensitively and appropriately. If you do provide information about your health or experiences as a breast cancer patient on this form, we will use that information in the same way. You can read more about how we will use your information in our privacy policy, or contact us if you’d like a paper copy. We will take great care to safeguard this information, and process it according to the General Data Protection Regulation and Data Protection Act 2018. Agreement Agreement * Agreement * I understand and agree to Breast Cancer Now using the information I provide for the above purpose. Submit Share this page Copy link
