Cancer Companions Online Training Registration

Thank you for registering for the Online Training

Please fill out the form below to register additional volunteers. (Note: If you purchase a starter kit after 9/25/18 your kit includes pricing for 3 training kits / volunteers. This form is to register additional volunteers over the 3 that were included in that kit).

Cancer Companions On-line Training 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 On-line Training Registration

For Anyone Coping with Cancer

For churches and interested volunteers

For Cancer Companion volunteers

Upcoming Events

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Password

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