Request a GIST Mentor

Thank you for your interest in a GIST Mentor. We will contact you as soon as possible after the submission of this form. If you need to speak to someone about the program, you can email The Life Raft Group directly at Liferaft@liferaftgroup.org.

Please note: Currently GIST Mentors are only available to those patients/caregivers in the U.S.

Full Name*

First NameLast Name

State of residence*

Are you currently an LRG member?*

YesNo

Are you a GIST patient or Caregiver?*

PatientCaregiver

If GIST Patient, what is your GIST type?

What is your preference?*

Female MentorMale MentorNo preference

E-mail*

Phone

Area CodePhone Number

If you provided a phone #, what is the best time to call?