Participation Form

We will notify the Study Coordinator for "Study to Help Lung Cancer Patients Quit Smoking," on your behalf, that you would like to participate in this study.

Please fill out the form below and click "Submit" to send a notification request.

or Cancel

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.