Aimee's Army
501(c)(3) Non Profit Organization

WEST SCRANTON CLASS OF 1980

IS PROUD TO HOST

GUEST BARTENDER NIGHT

JANUARY 18, 2010

KILCOYNE’S BAR

129 N MAIN ST. SCRANTON

7:00-11:00

Please if someone you know has been effected by a brain tumor take the time

 to fill this out. It only takes a few minutes, and the child you save maybe your own.

Landfills(miles)

Nuclear power plants(miles)

Other Chemical Plants(miles)

Drug plants (where there made)

Cell Phone Towers(miles)

Power lines or Power Boxes(miles)

Water Treatment Plants(miles)

Mold (Black)

Pesticides (what kind)

Household cleaning supplies (names most often used)

Soaps/Shampoos (names most often used)

Laundry detergent (names most often used)

Fabric Softener (names most often used)

Dishwashing detergent (names most often used)

Other heating (Wood, Kerosene, Coal)

Location at birth (city, state, zip code)

Location at DX (city, state, zip code)

Diagnosis (type of tumor)

(how long on B/C and how long off before getting pregnant)

(Or did you get pregnant while on the pill or other birth control)

Moody (how long before DX)

Accidents (falls, head, other)

Twins (gender)________Male__________Female

Ipods (little ear phones)

MP3 players (little ear phones)

CD players (little ear phones)

Hand held Video games (w/ear phones-hours )

TV Video games (how many hours)

Computer (how many hours on)

Pets (mostly exotic)

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OTHER THOUGHTS

__________________________________________________________________________

__________________________________________________________________________

The location at birth and DX will help me with my clustering project.

Since some doctors are stating that children are born with a DIPG/brain tumors that can help with the tracking. As to what the possible triggers can be.

If you can also please parents share occupation both at birth and DX. I have read somewhere that parents working with pesticides or other chemicals prior to conception can have ill effects on a child such as cancer.

Thank you to everyone for participating in this quest to find an answer. Also, note that due to HIPPA laws no names are required but can help if I should have question. I will not share the information on this form with anyone. The outcome will be done as a graph with statistics only showing numbers. Aimee's Army is working with researchers, in doing heat mapping into possible causes and clusters. Aimee has stated to me over and over again, that we can test drug after drug on these tumors but until we can have a conclusive answer to the cause the cure WILL NOT BE FOUND. It is the patient that will suffer more from the ill effects of all the chemo drugs more so then that of the tumors themselves.

Remember 1 in 330 children are diagnosed with cancer before the age of 19. 46 children each day are diagnosed with one form of cancer. If they survive to adulthood many have long lasting side effects or come down with a secondary cancer. Cancer is the number one cause of death in children by disease in the United States.

The number one risk factor in getting childhood cancer is being a child.

Please, mail completed forms to.

Aimee�fs Army

P.O. Box 37

Scranton, PA 18504

If you should have any question please e-mail me annette@aimeesarmy.com