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#CANCERSOLDIER REGISTRATION FORM
Be part of the dopest cancer awareness movement in Africa! Being a #Cancersoldier is a lifestyle, do not be left behind. Register today!
#Jointhemovement
* Required
Email address
*
Your email
First Name
*
Your answer
Middle Name
Your answer
Surname
*
Your answer
Gender
Male
Female
Other
Age
*
19-24yrs
25-30yrs
31-35yrs
36-40yrs
Above 40
Mobile Number
*
Your answer
Work Phone Number
Your answer
Postal Address
Your answer
Postal Code
Your answer
City/ County
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Your answer
Country
Your answer
Profession
*
Your answer
Do you have a #Cancersoldier gear (T-shirt) ?
Yes
No
Would you like to have a #Cancersoldier gear (T-shirt) @1500/-?
*
Yes
No
Would you like to volunteer/ Intern with us?
*
Volunteer
Intern
Other:
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