LRG GIST Membership 2026

The Life Raft Group Membership Form
The information provided by you in The Life Raft Group Membership Form helps us understand your GIST experience so we can provide personalized support, resources, and community connections. After you submit this form, a Life Raft Group (LRG) team member will contact you with a welcome and helpful information. LRG Membership and all resources are free.

Your privacy is very important to us. This form is HIPAA-compliant, and all personal and medical information you provide is kept strictly confidential. We use your information only to provide support, connect you with resources, and offer relevant community programs. Your data will never be shared without your consent. The information you provide will not be added to any registry, used for research, or shared with other organizations.

If you have any questions or need help completing the form, please call 973-837-9092 or email us at patientregistrydepartment@liferaftgroup.org.

* - mandatory field
Who is filling out this form?

Let us know your role and connection to GIST (Gastrointestinal Stromal Tumors).
I am a...*

PatientCaregiverFamily/Friend (Not an active caregiver)Medical ProfessionalLRG StaffOther (specify)
Please specify:
What is your relationship to the GIST patient?*

Spouse/PartnerParentChildSiblingFriendOther (specify)
Please specify your relationship to the patient:*
Contact & Demographic Information

By sharing your contact and demographic information, you help us connect you with helpful resources and programs, and allow us to better understand and support the GIST community.
Legal Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Ethnicity*

Alaskan NativeAmerican IndianArabAsian or Pacific IslanderBlack, not of Hispanic originBlack, of Hispanic originHispanicWhitePrefer not to answer
In which country do you live?*
Please select the state in which you live:*
Email*
example@example.com
Phone Number (please specify your country code and verify that your number is correct)*
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Method of Contact*

EmailPhonePostal MailWhatsApp
Professional Title*
Institution Name*
Specialty*
Secondary Contact Information

Please provide a secondary contact who we may reach out to if we are unable to reach you directly. This helps us ensure we can communicate important information when needed.
Secondary Contact Legal Name

First NameLast Name
What is this person's relationship to you?

Spouse/PartnerParentChildSiblingFriendOther (specify)
Please specify their relationship to you:
What country do they live in?
In which state do they live?
Secondary Contact Email
example@example.com
Secondary Contact Phone Number (please select the country code and verify the number is correct)
GIST Information

The following questions help us understand the GIST patient's experience in order to provide more personalized support, connect you with relevant resources, and better understand the needs of our community. The information you provide will not be added to any registry, used for research, or shared with other organizations.
Patient's Legal Name*

First NameLast Name
In which country do they live?
In which state do they live?
Patient Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Patient's GIST History

The following questions are in reference to the patient currently diagnosed with GIST.
GIST Diagnosis Date*

MonthDayYear
If you don't remember the exact date of diagnosis, please estimate. You may enter the 15th of the month, if only the month and year are known.
Do you (or the patient for whom you are submitting the form) currently have tumors?*

YesNo - currently no evidence of disease (NED)Not sure
Mutational/Genomic Details

Mutational testing checks the tumor’s genes for changes (mutations) such as KIT, PDGFRA, or NF1. This information usually appears in a molecular or genetic testing report, not the standard pathology report that describes the tumor’s appearance or pathology stains like DOG1 or cd117. If you don’t see this information, choose “I’m not sure.”
Did you (or the patient) receive mutational testing?*

YesNoAwaiting ResultsI'm not sure
If mutation is known, please specify:
Some common GIST mutation examples: Kit exon 11, Kit exon 9, PDGFRA D842V, SDH-deficient
Medication Information

These questions help us understand the current or past treatments related to GIST.
Are you (or the patient) currently taking or have taken any medications in the past for GIST?*

Yes, I am currently taking medicationNo, never taken any medicationsNo, not currently, but have taken medications in the past
To better understand the patient's treatment journey, please share the details of GIST medications taken. If you are currently taking medication, please leave the End Date for that record BLANK. (If you do not know the specific start or end dates of your medication, you may select the middle of the closest month, i.e. 1/15/2026, otherwise you may leave the dates blank.)*
Is there anything else you (or the patient) would like to share about the GIST diagnosis?
You can include additional details, experiences, or information you think would help us understand your diagnosis better. This field is optional.
Engagement

Let us know how you'd like to be involved with our LRG community. This helps us share available opportunities and connect you with the parts of the community that matter most to you.
I am interested in:*

FundraisingVolunteeringNewsletterGIST Chat - a private online discussion groupSupport GroupsI would like to receive information about clinical trialsI would like to request a GIST MentorI would like to enroll in the GIST Patient Registry (IRB-approved research database)
I am interested in:*

Contributing to the LRG Newsletter/Articles for websiteParticipating in LRG Data/Research Projects and CollaborationsParticipating in Virtual Tumor BoardsBeing listed as a GIST Specialist on the LRG WebsiteVolunteeringSupporting Fundraising Events
How did you hear about the LRG?*

Internet searchPatient Advocacy Website (e.g., Sarcoma Alliance, SPAGN, NORD, etc.)DoctorAnother LRG MemberOther
If internet, what source?

GoogleRedditChatGPT/AI ChatbotTikTokFacebookInstagramGIST Survivor Facebook Group
Please specify a Patient Advocacy Group:
Please specify the doctor's name:
Please specify the member's name:
Additional Information

This section gives you the opportunity to share any questions, support needs, or additional information. If you feel comfortable, you may also upload GIST-related documents to help our team better understand your experience before connecting with you.
How can we best support you? Please share any questions, concerns, or information you feel is relevant.*
Please list any skills/occupations/hobbies you would like to share with the LRG.
Report Uploads

Sharing any GIST-related reports - such as pathology, mutation, or imaging reports - before your LRG welcome call helps us understand your history and provide the most personalized support possible. This is not required, but it helps us better support you.
Max file size is 10.6 MB. This upload is HIPAA protected.

(If you need assistance with sharing reports, please contact: patientregistrydepartment@liferaftgroup.org)
Cancelof
Select Your Preferred Welcome Call Time

If you'd like to select preferred times for a welcome call, you are free to do so. This is completely optional. We will accommodate you as best we can and confirm that date as soon as possible. Otherwise, a member of our Welcome Team will reach out to you within 48 hours of your submission. Our Team is available Monday through Friday, 8:00 AM - 5:00 PM ET.
The dates and times you provide are optional and do not guarantee a confirmed appointment. We will review them and get back to you if they work for us.
Please verify that you are human*
By submitting this form, you'll receive an email confirming your submission at the email provided.
Should be Empty:

The Life Raft Group Membership Form

Who is filling out this form?

Contact & Demographic Information

Secondary Contact Information

GIST Information

Patient's GIST History

Mutational/Genomic Details

Medication Information

Engagement

Additional Information

Report Uploads

Select Your Preferred Welcome Call Time