Cancer Companions Online Training Registration

Thank you for registering for the Online Training

Please fill out the form below to register. (Note: a minimum of 3 people must be registered. If you have more than 5 please contact Marcy Wolf @ marcy@cancer-companions.org

Cancer Companions Online Training Pilot Registration

Church Name*
Church Address*

Street Address

Address Line 2

City

State

ZIP Code
Has your church purchased the required Cancer Companions starter kit to become a registered church?
- Yes
- No
Link to information about starter kit: https://www.cancer-companions.org/starter-kit-information/
Number of People for First Time Training*

Minimum of 3 people must register before a kit is shipped.
Primary Church Contact*

First

Last
Primary Contact Address*

Street Address

Address Line 2

City

State

ZIP Code
Primary Contact Phone Number
Primary Contact Email Address*

Enter Email

Confirm Email
Did you receive assistance from a Cancer Companion Representative?*
- Yes
- No
If YES, please provide representatives name

Cancer Companions Online Training Registration

Cancer Companions Online Training Pilot Registration

For Anyone Coping with Cancer

For churches and interested volunteers

For Cancer Companion volunteers

Upcoming Events

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