'26-'27 Program Sign Up Form
Ready to get creative with us? 🌵 Fill out this form and select the workshop you’d like to attend! Because our programs are intentionally kept cozy and community-centered, submitting this form does not guarantee a spot. Once registrations close, our team will review submissions based on program capacity and availability.If you’re selected to participate, we’ll send you a confirmation email with all the exciting details. If we aren’t able to accommodate you this time around, we’ll still reach out so you’re not left wandering the desert wondering what happened. Questions along the way? We’re always happy to help, just reach out to our team!
Programs Available:
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Email
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example@example.com
Name
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First Name
Last Name
I am a...
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young adult cancer patient/survivor
young adult cancer co-survivor / caregiver
other
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?
Metastatic
Chronic
No / 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)
Brain
Brain- Glioma
Breast
Cervical
Chronic Myeloid Leukemia (CML)
Colon
Colorectal
Endometrial
Esophageal
Ewing's Sarcoma
Hodgkin Lymphoma
Kidney
Leukemia (other)
Lung
Neuroendocrine
Non-Hodgkin Lymphoma
Osteosarcoma
Ovarian
Melanoma
Multiple Myeloma
Sarcoma (other)
Thyroid
Testicular
Uterine
Other
Where are you in your cancer experience?
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newly diagnosed (haven't started treatment yet)
in treatment
less than 1 year out of treatment
1 year out of treatment
2 years out of treatment
3 years out of treatment
4 years out of treatment
5+ years out of treatment
a caregiver
other
Do you have any accessibility needs we can help accommodate?
If not, you can just leave this blank!
I am...
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18-45 years old
46+ years old
How do you racially identify yourself?
*
American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latinx or Spanish Origin of any race
Middle Eastern or Northern African
Native Hawaiian or Other Pacific Islander
White
Race and Ethnicity Unknown
Prefer Not to Disclose
What is your gender?
*
Cisgender Man
Cisgender Woman
Non-Binary
Transgender Man
Transgender Woman
Prefer Not to Disclose
Other
What is your sexual orientation?
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Asexual
Bisexual
Gay
Heterosexual
Lesbian
Pansexual
Queer
Prefer Not to Disclose
Other
What best describes where you live?
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Suburban
Urban
Rural
Other
Address
*
Please double check this for accuracy so we can send supplies to you!
Street Address Line 2
City
State / Province
Postal / Zip Code
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
*
Street Address
Street Address Line 2
City
State / 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 due to USPS delays, weather, and other unforeseen circumstances. I agree to still come to the program if I don't have a package, to learn and connect with the YA cancer community. If I choose, I can request a list of supplies to try and replace on my own.
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Sounds good, I'm in!
Nah- give up my space and I'll look at other programs to join! (selecting this will void your registration)
I understand that filling out this form does not guarantee me a spot in the workshop I’m signing up for. If Cactus Cancer Society is able to accommodate me based on program availability and capacity, I’ll receive a follow-up email confirming my participation.
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Yup, that makes sense!
Eh, never mind you can count me out. (selecting this will void your registration)
By signing up for this workshop, I agree to the following attendance expectations: 1. I plan to attend the full two-hour workshop and keep my camera on during the session. 2. If I can no longer attend, I will email Cactus Cancer Society as soon as possible so my spot can be offered to someone else. 3. I understand that if I miss a workshop for reasons outside of my control, without notifying Cactus Cancer Society ahead of time, I may not be eligible to participate in the next workshop I register for. These guidelines help us make the most of our limited program spots and create a connected, safe, engaging experience for everyone. 🌵
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Yes, I'm in!
No, I'm kinda on the fence! Don't count me in! (selecting this will void you registration)
Please verify that you are human
*
If there's anything else you'd like us to know, please email us at programs@cactuscancer.org.
Thank you!
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