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First name *

Surename *

Date of birth *

Gender at birth * Select…MaleFemale

Address *

Zip *

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Skin Type
What definition suits the best? Please choose: drop down list * Select…Type IType IIType IIIType IVType VType VI

Have you previously been diagnosed with melanoma or any other type of skin cancer which was verified by histology? * Select…NOMelanomaNon-melanoma skin cancerI do not know

Is there a history of melanoma in your family? * Select…NOClose familyDistant familyI do not know

Have you had frequent sunburns, especially severe (blistering) sunburns during childhood? * Select…NOA fewA lotI do not know

How much time have you typically spent outdoors in the sun throughout your life so far? * Select…Barely anyLess than averageAverageQuite a lot of sun exposureExtreme sun exposure, like growing up in Australia

Do you use sunscreen regularly in appropriate strength? * Select…NOSometimesReligiously

How many moles can you count on your right arm? Please, count it and submit the number. *

Have you used tanning beds or sunlamps? * Select…NeverSometimesA lot

Have you ever had an organ transplant, or are you immunosuppressed for any other reason (e.g., HIV/AIDS, immunosuppressive drugs for autoimmune diseases,chemotherapy)? * Select…NOYES

Your health data will only be processed with your explicit consent. Please provide this by ticking the checkbox before you finalise your registration. For detailed information, please read our Privacy Notice. *

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