Exposure Survey Question Title * 1. Full name Question Title * 2. Date of birth Question Title * 3. GMB Membership number Question Title * 4. Occupation/Employment at the time of exposure Question Title * 5. Where/when did exposure happen Question Title * 6. Were you regularly exposed to cigarette smoke now or in the past Yes No Question Title * 7. Employer name Question Title * 8. Cancer diagnosis date Date / Time Date Question Title * 9. Type of cancer diagnosed with Question Title * 10. I agree for UnionLine to contact me Yes No Question Title * 11. I Consent to share information with Fight Bladder Cancer Yes No Done