California Consumer Privacy Act Request

Name:*

First NameLast Name

I am a California resident: Yes or No*

YesNo

*Please note you must be a California resident to request information based on the California Consumer Privacy Act. No further action can be taken on this form. For more information about our Terms and Conditions or Privacy Policy, please click one of the following links.

- Our Terms and Conditions
- Privacy Policy

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email:*

example@example.com

Phone Number

Area CodePhone Number

Type of Request

Access Request: Please send me a copy of the information that Hope4Cancer has collected about me in the last 12 months.Request to Know: Categories of personal information collected about me in the last 12 months.Request to Know: Categories of sources from which the personal information about me was collected.Request to Know: Business purpose for which Hope4Cancer uses the personal information collected about me.Request to Know: Categories of third parties with whom Hope4Cancer shares or has shared information collected about me in the last 12 months.Request for Deletion: Please delete all personal information that Hope4Cancer has collected from me.Request to Opt Out: I do not want my personal information sold. Please cease and refrain from selling my personal information.

This request has been submitted through an agent on my behalf:

YesNo

Agent's Name:

First NameLast Name

This agent has been authorized in writing to submit this request on my behalf:

YesNo

Please verify that you are human*