STOP - GFN

S.T.O.P. - Stop the Observed Pollution

OUR FIRST MEETING AUGUST 24TH

MESSAGE FROM THE FOUNDER

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HAVE YOU OR AN IMMEDIATE FAMILY MEMBER RECEIVED A CRITICAL ILLNESS AND LIVED OR WORKED AROUND THE MEMPHIS ARMY DEPOT?

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Critical Illness Study - Memphis Army Depot Victims

This study is for those that lived or worked around the Memphis Army Depot between 1946-to present for at least 30 days and subsequently enquired ANY type Cancer, Parkinson’s disease, or other serious illnesses. You may be included in a lawsuit for significant compensation and health benefits information. There is a limited time to be added to this study. Please return this form as soon as possible and contact others who lived in the affected area to be included.

Contact Information:

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WHAT IS THE BEGINNING DATE AND THE ENDING DATE THAT YOU OR YOUR RELATIVE WERE IN THE AREA (USE MM/DD/YEAR)

USE (MM/DD/YEAR TO MM/DD/YEAR)

Deceased Victim Information

DECEASED_VICTIMS_NAME

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DECEASED_VICTIMS_PRIOR_ADDRESS

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NAME_OF_RELATIVE_OF_DECEASED_VICTIM

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HOW_ARE_YOU_RELATED

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DOCTOR_OF_VICTIM

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Crtical Illness

Have you or your relatives been diagnosed with any of the following diseases?

Diseases Covered in this Study:

APLASTIC ANEMIA

BLADDER CANCER

BREAST CANCER

ESOPHAGEAL CANCER

FEMALE INFERTILITY

HEPATIC STEATOSIS (FATTY LIVER DISEASE)

KIDNEY CANCER

LEUKEMIA

LIVER CANCER

LUNG CANCER

MISCARRIAGE

MULTIPLE MYELOMA

MYELODYSPLASTIC SYNDOMES

NEUROBBEHAVIORAL EFFECTS

NON-HODGKIN'S LYMPHOMA

PARKINSON'S DISEASE

RENAL TOXICITY

SCLERODERMA

Other Serious Disease Not Mentioned

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Your Required Demographics

Ethnic Group

AFRICAN AMERICAN

CAUCASIAN

HISPANIC

ASIAN

OTHER

Age

18-30

30-55

55-75

75+

Are you a smoker?

yes

Do you want information on how to stop smoking?

yes

Have you been in the presence of a person who smokes?

yes

RELIGIOUS_PREFERENCE

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Do you want a visit from the pastor

yes

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