WAITLIST for 25-26 Sign Up Form

WAITLIST Program Sign Up Form

It looks like the program you're trying to sign up for is already full! We always strive to accommodate as many participants as possible. In the event that we are unable to offer you a spot from our waitlist, please know that your sign-up helps inform us of the community's needs, and describe our need to expand programs at Cactus Cancer Society.
Email*
example@example.com
Name*

First NameLast Name
My Products*
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WAITLIST-January Art Workshop: Zine & Be Seen Thursday, Jan 29 | 4pm–7pm PT / 6pm–9pm CT / 7 pm–10pm ET
$ Free



WAITLIST-Love Notes & Little Joys: Valentine Card Workshop Thurs Feb 5th 4pm-6pm PT/6pm-8pm CT/7pm-9pm ET
$ Free



WAITLIST- February Builders: The Wednesday Anti-Valentine Black Dahlia Tuesday Feb 3rd @ 5pm-7pm PT/7pm-9pm CT/8pm-10pm ET
$ Free
I am a...*

young adult cancer patient/survivoryoung adult cancer co-survivor / caregiverother
Have you previously participated in any programs with Cactus Cancer Society?*

Yes, including this program!Yes, but not this program!No, it's my first time here!
Are you facing metastatic or chronic cancer?

MetastaticChronicNo / I Don't Know
What type of cancer were you (or the person you're caring for) diagnosed with?*

Acute Lymphocytic Leukemia (ALL)Acute Myeloid Leukemia (AML)BrainBreastCervicalChronic Myeloid Leukemia (CML)ColonColorectalEndometrialEsophagealEwing's SarcomaHodgkin LymphomaKidneyLeukemia (other)LungNeuroendocrineNon-Hodgkin LymphomaOsteosarcomaOvarianMelanomaMultiple MyelomaSarcoma (other)ThyroidTesticularUterineOther
Where are you in your cancer experience?*

newly diagnosed (haven't started treatment yet)in treatmentless than 1 year out of treatment1 year out of treatment2 years out of treatment3 years out of treatment4 years out of treatment5+ years out of treatmenta caregiverother
Do you have any accessibility needs we can help accommodate?
If no, you can just leave this blank!
I am...*

18-45 years old46+ years old
How do you racially identify yourself?*

American Indian or Alaskan NativeAsianBlack or African AmericanHispanic or Latinx or Spanish Origin of any raceMiddle Eastern or Northern AfricanNative Hawaiian or Other Pacific IslanderWhiteRace and Ethnicity UnknownPrefer Not to Disclose
What is your gender?*

Cisgender ManCisgender WomanNon-BinaryTransgender ManTransgender WomanPrefer Not to DiscloseOther
What is your sexual orientation?*

AsexualBisexualGayHeterosexualLesbianPansexualQueerPrefer Not to DiscloseOther
What best describes where you live?*

SuburbanUrbanRuralOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Street Address

Street Address Line 2

City

Zip Code
Street Address

Street Address Line 2

CityState

Zip Code
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country*
I understand Cactus Cancer Society does their very best to accommodate shipping requests, but cannot guarantee that supply packages will arrive in time. I agree to still come to the program if I don't have a package, to learn and connect with others like me. If I choose, I can request a list of supplies to try and replace on my own.*

Sounds good, I'm in!Nah- give up my space and I'll look at other programs to join!
By signing up, I agree to adhere to the attendance policy as follows: I understand that if I miss a single Workshop, I will not be allowed to participate in the following workshop I sign up for. I also plan on attending for the full two hours and agree to have my camera turned on in order to respect the Cactus Cancer Society's program capacity limits.*

Yes, I'm in!No, I'm kinda on the fence! Don't count me in!
If there's anything else you'd like us to know, please email us at programs@cactuscancer.org.

Thank you!
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WAITLIST Program Sign Up Form

If there's anything else you'd like us to know, please email us at programs@cactuscancer.org.