Name *

First Name

Last Name

Select all that apply:

Childhood Cancer Survivor

Parent of a Child with Cancer/Survivor

Bereaved Parent

Advocacy Organization Member

Medical Professional

Other

Which childhood cancer issues are you most passionate about?

You may select more than one.

Survivorship Issues

New Treatments

Insurance/Financial Issues

Advocacy Engagement

Patient/Family Support Programs

Fundraising

Other

Take your advocacy to the next level! Would you be willing to do any of the following in 2018?

Share your childhood cancer story with our network through our website and social media.

Write a guest blog about your advocacy experience.

Meet with your Member of Congress in a nearby District Office.

Write a letter to the editor of your local paper.

Organize an event in your area to introduce new people to our cause. (It could be as simple as a postcard-writing gathering at your neighborhood coffee shop) We can work with you to make it happen!