"S&P" (Share & Pray)
Saturday, 07 Sep 2024
Availability (Please tick if you would like to proceed with the registration)
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Participant's Name
*
Given Name
Surname
Please tick?
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Patient
Survivor
Direct/Main caregiver
Patient (currently receiving treatment) Condition:
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Survivor of
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Direct/Main Caregiver to
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spouse
father/mother
brother/sister
in laws
friends
Other
Cancer of
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Gender
*
Male
Female
Mobile Number
*
Email Address (Please enter twice)
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Confirmation Email
(For confirmation)
Address
*
Which Church are you Attending?
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Wesley Methodist Church
Other
Occupation
*
Today's Date of Registration
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-
Day
-
Month
Year
Date (DD/MM/YYYY)
General Consent Statement
*
Wesley Methodist Church is committed to safeguarding your personal information. In submitting this form, you agree and consent to the use of your information for Wesley Women's Cancer Support Group, Church activities, programmes and services.
For further assistance, please email
evelync@wesleymc.org
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