Breast Care Nurse affiliated membership form

Please complete this form to help us support you in your clinical role and provide ongoing professional development opportunities. You will become an affiliated member of Cancer Council Victoria's Cancer Information and Support Service, and be included in our database.

Required fields are marked: * 

Personal details
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Employment details
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LaTrobe intake details
Full-time Part-time Not employed
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Ongoing information and support resources

Please select from the following ways we can support you in your role:
*  Weekly cancer news email update
Cancer News (our quarterly newsletter)
Seminars/education for health professionals
Seminars/events for cancer patients
Seminars/events for carers/family & friends
A call from a Helpline nurse to update you on the latest program updates, debriefings or links to latest research
Electronic journal updates
Request a visit from our Community Engagement Program Manager
Links to online support groups & forums for patients, family & friends
Electronic referral form for peer support matching service
Access to Cancer Council literature & resources

Information handling

All information provided will be stored in a secure database that only authorised Cancer Council staff can access. Feel free to update your professional details as they change by submitting another form or calling the Cancer Council Helpline on 13 11 20.

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Donate to Cancer Council Victoria
Cancer Council Helpline 13 11 20