24-25 Sign Up Form

Program Sign Up Form

August 2024- June 2025
Email*
example@example.com
Name*

First NameLast Name
I am a...*

young adult cancer patient/survivoryoung adult cancer caregiverOther
Available Workshops: (If the program you are trying to register for is "sold out" please follow this link, https://form.jotform.com/CactusCancer/waitlist2425form, to the waitlist!)*
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Survivorship Series for Metastatic Breast Cancer! Zoom: Wednesdays, February 26th-March 19th 4-6pm PT / 6-8pm CT / 7-9pm ET, Online Group Activities March 26th-April 19thBe part of a very interactive 8-week, online program experience where you’ll hit the highlights of our workshops! Participated in the past? No worries! This is a new version and past participants are welcome to register. **Please note this cohort of participants is for patients and survivors who are facing a metastatic breast cancer diagnosis. If this isn't you, we kindly ask that you wait to join a different program.**
$ Free



March Art Workshop, Oyster Shells: Tuesday, Mar 25 @ 3-5 pm PT / 5-7pm CT / 6-8pm ETCreate some beautiful oyster shells like the picture above with decoupage style steps! You’re sure to have the best time getting your hands dirty while being with other young adults facing cancer. You wont want to miss it!
$ Free



Lost and Found: Thursday, April 3-April 24 @ 3- 4:30 pm PT / 5-6:30pm CT / 6-7:30pm ETJoin other young cancer survivors (women only) who understand what you’ve gone through while learning how to reconnect, welcoming a compassionate understanding of your body now, and creating ways to open your heart to intimate opportunities after cancer.
$ Free



Storymapping, Spring 2025: Tuesdays, April 22 - May 13th @ 3-5pm PT / 5-7pm CT /6-8pm ETCombine the power of storytelling with the art of graphic representation and you’ve got Cactus Cancer Society’s annual program: Story Mapping! This workshop is about empowering young adults who are at any stage of their cancer experience to find their voice, tell their story, and thrive by appreciating the challenges and gifts inherent in any cancer experience. Spread out over four weeks, we’ll craft our cancer stories, map it out, and have a sharing session within our intimate workshop group.
$ Free
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!Other
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 LymphomaLeukemia (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 treatmentmetastaticchronica 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 DiscloseOther
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

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CityState / Province

Postal / Zip Code
Street Address

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City

Zip Code
Street Address

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CityState

Zip Code
Street Address

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

Thank you!
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Program Sign Up Form

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