Sign up – Peer to Peer Peer to Peer Step 1 of 4 - Background Info 0% First Name*Last Name*Date of Birth* Date Format: MM slash DD slash YYYY Gender*MaleFemaleStreet Address*City*Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweUS State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificState/Province (outside the US)Zip / Postal Code*Preferred Communication Method*emailphoneeitherPhone*Email*How long have you known about The Sarcoma Alliance?*Less than 1 monthOne to 6 monthsSix months to 1 yearOne to 3 yearsMore than 3 yearsHow did you first hear about The Sarcoma Alliance (SA) Peer-to-Peer Network?*SA Website AdSA Message Board PostSA Online Chat RoomSA Newsletter / MailingFriends / FamilyHealthcare ProviderOtherIf Other, Please Specify: Are you:*a sarcoma survivorclose to someone affected by sarcomaWhat is/was your relationship to the person affected by sarcoma?*Primary caregiver to a child with sarcomaPrimary caregiver to an adult with sarcomaOther caregiverOtherIf Other, please specify:When was the initial diagnosis with Sarcoma? (estimated date)* Date Format: MM slash DD slash YYYY What Type of Sarcoma?*Alveolar Soft Part SarcomaAngiosarcomaChondrosarcomaClear Cell SarcomaDermatofibrosarcoma ProtuberansDesmoplastic Small Round Cell Tumor (DSRCT)Endometrial Stromal Tumor (ESS)Epithelioid SarcomaEwing's SarcomaFibrosarcomaGastrointestinal Stromal Tumor (GIST)HemangiopericytomaKaposi’s SarcomaLeiomyosarcoma (LMS)LiposarcomaMalignant Fibrous Histiocytoma (MFH)Malignant Mixed Mullerian TumorMalignant Peripheral Nerve Sheath Tumor (MPNST)MesenchymomasMyxoid FibrosarcomaMyxomaOsteosarcomaPleomorphic Undifferentiated SarcomaPrimitive Neuroectodermal Tumor (PNET)RhabdomyosarcomaRetroperitoneal SarcomaSpindle Cell SarcomaSynovial SarcomaUndifferentiated SarcomaUnclassified / Not ListedUnknownNo DiagnosisWhat best describes the original location of the sarcoma?* Upper Extremity Lower Extremity Abdomen / Trunk Chest Head / Neck Female reproductive tract Genitourinary Heart / Great Vessels Central Nervous System Has the sarcoma metastasized to additional location(s)?*Never have had metastasesMetastasis at time of initial diagnosisMetastasis found subsequent to initial diagnosisIs the person affected by sarcoma still living?*YesNoIf so, is treatment ongoing?*YesNoWhen was the last treatment? Date Format: MM slash DD slash YYYY Person's Current State of Health*ExcellentGoodFairPoor What is your preferred role with in the Peer to Peer network?*to get support from someone more experiencedto help someone new to the communityto be matched with someone at a similar level of experienceno preferenceWould you be willing to be matched with more than one person?*YesNoMaybeFor each of the following factors, please rate how important it is for you to be matched with someone who is similar: Not at allA little bitModeratelyVeryEssentialAge*Not at allA little bitModeratelyVeryEssentialGender*Not at allA little bitModeratelyVeryEssentialDisease Type*Not at allA little bitModeratelyVeryEssentialDisease Location*Not at allA little bitModeratelyVeryEssentialCurrent State of Health*Not at allA little bitModeratelyVeryEssentialTime Since Initial Diagnosis*Not at allA little bitModeratelyVeryEssentialPlease provide any additional information that you would like to have considered when you are being matched in the Peer to Peer network:Would you like to be added to our mailing list?*YesNo I wish to participate in The Sarcoma Alliance Peer to Peer Network. I hereby authorize The Sarcoma Alliance to use the information listed above for the express purpose of establishing and operating the Peer to Peer network. I avow that I have read the guidelines of the Peer to Peer network and agree to abide by all of the terms listed. I verify that I am at least 18 years of age and that the information I have provided is true and correct to the very best of my knowledge.* I agree PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.