EORTC MELANOMA GROUPYOUNG INVESTIGATORS QUERY FORM Personal Information (1/4) Your Name:* Affiliation:* E-Mail:* Country* Choose one Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Antilles, Netherlands Arabia, Saudi Argentina Armenia Aruba Asia Pacific Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Rep. of the Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Czechoslovakia (Former) Denmark Djibouti Dominica Dominican Republic East Timor (Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia European Union Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories - TF Gabon Gambia, the Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guerney Guinea Guinea-Bissau Guinea, Equatorial Guiana, French Guyana Haiti Heard and McDonald Islands Holy See (Vatican City State) Holland (see Netherlands) Honduras Hong Kong, (China) Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Ivory Coast (see Cote d'Ivoire) Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Demo. People's Rep. of Korea, (South) Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao, (China) Macedonia, TFYR Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (ex-Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia (Russian Federation) Rwanda Sahara Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia & Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa S. Georgia and S. Sandwich Is. Spain Sri Lanka (ex-Ceilan) Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste (East Timor) Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States US Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe I am :* Choose one I am a Melanoma Group Member (Active member) I am a Melanoma Group Member (YIN) I am a Melanoma Group Member (Steering Committee) I am NOT a Melanoma Group Member Reset submit Please turn on javascript to submit your data. Thank you! Next
