24-25 Sign Up Form

Program Sign Up Form

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

First NameLast Name
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: Late FallJoin 25 of your young adult cancer peers, ages 18-45, through an eight-week program experience where you’ll hit the highlights of Cactus Cancer Society’s workshops. The first four weeks on Wednesdays, starting October 16th through November 6th, we’ll meet on Zoom from 4:00-6:00pm PT / 6:00-8:00pm CT / 7:00-9:00pm ET, where you’ll attend a Game Night, a Journaling Workshop, an Art Workshop, and a Young Adult Cancer Hangout. The following four weeks will be comprised of at-home activities for you to participate in our private Geneva group!
$ Free



November Guys Only Builders Workshop: Tuesday, November 26, 2024 @ 5:00-7:00 pm PDT/7:00-9:00pm CT /8:00-10:00pm ETJoin other dudes in the Cactus Cancer Society Community for a special spotlight on No Shave November. We’ll send you everything you need to participate, including a sweet Indiana Jones LEGO and new to Builders’, alternative build instructions!
$ Free



It's a Wonderful Life 2024: December 5th/December 12th/December 19th at 3pm PT/ 5pm CT / 6pm ETJoin LCSW Jean Rowe for Cactus Cancer Society’s annual holiday three week journaling workshop. Plus, this year, you’ll get a special journaling package in the mail to participate!
$ 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
I am a...*

young adult cancer patient/survivoryoung adult cancer caregiverOther
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

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!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.