Re: Cancer Volunteer Application

Thank you for your interest in volunteering with Re: Cancer.

Our Program Manager will contact you within 48 hours.  

Country
State / Province*
Address
City
Email*
Confirm Email*
Phone*
Date of Birth*
Ethnicity
  • African American
  • Asian
  • Caucasian
  • Hispanic
  • Native American
  • Pacific Islander

 

Are you a Survivor?

Which type of cancer did you have?
  • Adenoid
  • Appendix
  • Bladder
  • Bone
  • Brain - glioblastoma
  • Brain - meningioma
  • Brain - unknown type
  • Breast - DCIS
  • Breast - IBC
  • Breast - IDC
  • Breast - ILC
  • Breast - LCIS
  • Breast - unknown type
  • Colon
  • Endometrial
  • Esophageal
  • Head and Neck
  • Kidney
  • Leukemia - ALL
  • Leukemia - CLL
  • Leukemia - CML
  • Leukemia - unknown type
  • Liver
  • Lung
  • Lymphoma - Hodgkins
  • Lymphoma - NonHodgkins
  • Multiple Myeloma
  • Ovarian
  • Pancreatic
  • Prostate
  • Rhabdomyosarcoma
  • Soft Tissue Sarcoma
  • Testicular
  • Throat
  • Thyroid
  • Tongue
  • Urachal
  • RARE CANCER
  • Other



Did you care for a family member who had cancer?

Which Family Member had cancer?
  • Aunt
  • Boyfriend
  • Brother
  • Brother-in-law
  • Cousin
  • Daughter
  • Father
  • Father-in-law
  • Fiance
  • Friend
  • Gay Partner
  • Girlfriend
  • Grandfather
  • Grandmother
  • Husband
  • Mother
  • Mother-in-law
  • Sister
  • Sister-in-law
  • Son
  • Uncle
  • Wife
  • Other
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