FloridaBOB Membership Registration Form. Please fill in the form below. All Cells That Are Marked With An (*) Are Required Cells And Must Be Filled In Email: * Login: * Choose password: * Verify password: * A.) Last Name: * B.) First Name: * C.) Spouse: D.) Address: E.) City: F.) State: G.) Zip Code: H.) Home Phone #: I.) Cell Phone #: J.) Type of Cancer Being Treated: K.) Form of Treatment Receiving: L.) PSA at Start of Treatment: M.) PSA at End of Treatment: N.) Gleason Score at Start of Treatment: O.) Treatment Start Date: P.) Treatment End Date: Q.) Age at Start of Treatment: R.) Any Side Effects Since Start of Treatments: S.) What Side Effects Have You Experienced: T.) Can We Share Your Information With Prospective Patients: U.) Are you Receiving The Balloon or Saline Solution: V.) Have You Been Treated For Cancer Before: W.) What Form of Treatment Did You Receive: X.) Did Your Urologist Refer You For Proton Treatments or Are You Self Referral: