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About Wings of Hope
Anti-Discrimination Policy
Governing Board
About
About Wings of Hope
Anti-Discrimination Policy
Governing Board
Calendar
Eating Well
Gallery
Give2Wings
Guided Imagery
Hair Stories
Healing Garden
Honors
News
Services | En Espanol
Wine-d Down
Contact
Wings of Hope Cancer Support Center Form
Name
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Phone
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Age or date of birth
*
Gender
*
Male
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Affiliation
*
Please describe your relationship with Wings of Hope Cancer Support Center
Preferred contact method
*
Email
Mail
Phone
What inspired you to connect with us?
*
Community involvement | volunteer experience
*
Please list your community involvement and volunteer experience.
Accommodations needed
Please list any accommodations you need to use our services | attend our events.
Would you like to volunteer or attend our events?
*
Yes
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Media release consent
*
By checking this box, I grant Wings of Hope Cancer Support Center permission to use my name, likeness, image, voice and/or statements in photographs, videos or other media for promotional, educational or fundraising purposes. I understand these materials may be used in printed or digital publications, websites, social media or other formats.
I agree to the media release terms.
I do not agree to the media release terms.
Thank you!