Coalition for Pulmonary Fibrosis


	Coalition for Pulmonary Fibrosis Suite F, #227 1659 Branham Lane San Jose, CA 95118-5226 (888) 222-8541 info@coalitionforpf.org

Membership in the CPF is open to all individuals and organizations interested in promoting awareness of pulmonary fibrosis and in helping to advance pulmonary fibrosis education, patient support, treatment, and research. No membership fee is required, though donations are encouraged.

Membership Benefits
Include

• E-mail updates on breaking pulmonary fibrosis news

• Access to the latest information on clinical trials

• A free subscription to the CPF Action Alert Quarterly newsletter

• Information on local education and awareness events

• Access to peer-reviewed educational materials authored by our world-class scientific advisory board

• Opportunities to become involved in education and awareness efforts in your community

• Recognition as a CPF partner (organizations only) in all public information and materials

Please Complete this form to Join

*Required fields

I am a...:

Name:

Title:

Organiztion/Institution:

Department:

Address:

City:

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email:

Comments:

Please Complete this portion of the form only if you are a patient or
a family member of a Patient with IPF....

Do you have IPF:

Yes No

Date of diagnosis:
(mm/dd/yyyy)

My diagnosis was confirmed by (check all that apply)

High-Resolution Computer Tomography Scan (HRCT)
Bronchoalveolar lavage
Chest radiography (x-ray)
Surgical Lung biopsy
Arterial blood gas (ABG)
Pulmonary function test (PFT)
Bronchoscopy

These Documents available to US & Canadian residents only.

I understand that all CPF educational materials and resources are available on the CPF Web page, however I do not have an internet connection that I can regularly access, and would like to receive the CPF's Resource Kit by mail.

I represent the office of a physician or healthcare professional, and would like to receive copies of "Let's Talk About IPF" brochure for our patients.

I represent the office of a physician or healthcare professional, and would like to receive copies of "Oxygen Management & Pulmonary Rehabilitation for the IPF Patient" brochure for our patients.

I represent the office of a physician or healthcare professional, and would like to receive copies of "Lung Transplantation: What Every Patient with IPF Should Know" brochure for our patients

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property of their respective owners. ©2001 - 2007 Coalition for Pulmonary Fibrosis

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