Registration/Sign in

Thank you for visiting The Prostate Cancer Registry. We ask that you read the following information in order for you to make an informed decision to take part in the Registry.

Registration Form (all fields are required)

Please enter your first and last name and email address below. You will need to create a username and password. Passwords should be at least 8 characters.

Username *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.

E-mail address *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password Requirements

Password *

Confirm password *

Provide a password for the new account in both fields. Password must be at least 6 characters.

I Accept (required) *

Consent Form (required)

I, freely and voluntarily, and without element of force, consent to participate in this prostate cancer registry. I understand the purpose of this study is to provide prostate cancer survivors a unified voice to advance understanding of the challenges that universally affect prostate cancer survivors.

I understand that I will be asked to fill out an online questionnaire, which will examine my demographics, prostate cancer information, and data regarding my experience with prostate cancer. All activities will be completed online.

I understand that there are benefits for participating in this project. I will provide professionals valuable information about prostate cancer survivorship. This registry is an important step to provide support and empower survivors as they transition from active treatment to post-treatment. The anticipated benefits of gaining insights into the practices about prostate cancer, contributing factors and challenges, and perceived critical issues facing African-American men, outweigh any risk.

I understand my participation is totally voluntary and that I may stop participation at any time. All my answers to the questionnaire will be kept confidential. I understand that my name will not be reported. Only group findings will be reported.

I understand that this consent may be withdrawn at any time without prejudice, penalty, or loss of benefits to which I am otherwise entitled. I have been given the right to ask, and have answered, any inquiry concerning the study. Questions, if any, have been answered to my satisfaction. I have read and understand this consent form.

I understand that I may contact Dr. Kimberly Davis at Clark Atlanta University, Center for Cancer Research and Therapeutic Development, 223 James P. Brawley Drive SW, Atlanta, GA 30314, (404) 880-6878 or at cancerinfo@cau.edu for information or questions about this study or my rights. Group results will be sent to me upon my request.

If I have any questions about my rights as a subject/participant in this research, or I feel that I have been placed at risk, I realize I can contact the Clark Atlanta University, Office of Research and Sponsored Programs at (404) 880-6979.

I have read this page. By clicking “I Accept” I agree to provide my information and responses to be used for research purposes through The Prostate Cancer Registry.

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