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Suggested Reading Submission Form
Title of Book
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Author's Name
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Author's Credentials (if applicable)
Published Date (Requests for non-published books will not be accepted.)
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ISBN #:
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Where is the book available?
Fill in each that applies:
Online store
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Book store
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Author's website
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Other
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In which formats are the book available?
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Print
eReader
Audio
Other
Other
Please provide a brief summary of the book.
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0/500 characters
Target Audience (check all that apply)
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Children
Teens
Adults/Caregivers of adults
Parents
Other
Other
Topic (check all that apply)
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Cancer in the Family
Caregiving
Complementary Approaches and Nutrition
Coping with Illness
Death and Dying
Decision Making
Disease-Specific Reference Books
Financial/Legal
Grief
Inspiration
Living with Cancer
Side Effects
Treatment
Other
Other
How did you hear about LLS?
*
Conference
Email
Google/internet search
LLS Community
LLS Website
Local LLS chapter
Mail
Physician/healthcare professional
Poster
Social media
Other
Other
Contact Information
We will reach out to you with next steps for submitting your book.
First Name
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Last Name
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Email Address
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Please confirm your email address.
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Phone Number
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Zip Code
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Would you like to receive emails about education and resources from LLS?
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Yes, please keep me up to date.
No, thank you.
I am a:
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Patient/Survivor
Caregiver
Family Member
Friend/Concerned Individual
Healthcare Professional
Other
If other, please specify.
What is your/the patient's date of diagnosis? (If applicable)
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My or my loved one's diagnosis is (if applicable):
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Leukemia
Lymphoma
MDS (Myelodysplastic Syndrome)
Myeloma
Myeloproliferative Neoplasms
Other
N/A
Leukemia Disease Type
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Adult T-leukemia/Lymphoma
ALL (Acute Lymphoblastic Leukemia)
AML (Acute Myeloid Leukemia)
APL (Acute Promyelocytic Leukemia)
B-Prolymphocytic Leukemia
Chronic Eosinophilic Leukemia
CLL/SLL (Chronic Lymphocytic Leukemia/Small cell lymphoma)
CML (Chronic Myeloid Leukemia)
CMML/JMML
Hairy Cell Leukemia
LGL (Large Granular Lymphocytic) Leukemia
Mixed Lineage Leukemia
NK Cell Leukemia
Lymphoma Disease Type
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Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Myeloproliferative Neoplasms Disease Type
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Essential Thrombocythemia
Polycythemia Vera
Primary Myelofibrosis
Other Disease Type
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Disease unknown
Other Blood Cancers
Other Non-Hematologic Cancers
Other non-malignant disease
Type
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Child Life Specialist
Health Educator
Hematologist/Oncologist
Nurse
Nurse Practitioner
Pharmacist
Physician
Physician's Assistant
Primary Care Physician (PCP)
Psychologist
Social Worker
Other