East Georgia Cancer Coalition (EGCC) Survivor Wellness

Please use this form to register for the East Georgia Cancer Coalition (EGCC) Survivor Wellness class if you are not a Ramsey member and would like to participate in the Survivor Wellness class with the EGCC providing payment OR if you are a Ramsey member and would like the EGCC to pay for your class pass.

Survivors, survivors' family members and/or friends may register for this class.

If you are a Ramsey member and would like to pay for your class, please register through your online portal.

If you have any questions, please call (706) 542-6449.

Email address *

Name *

Your answer

Phone number

Your answer

Sex *

Male

Female

Birthday *

YYYY

Are you currently a Ramsey member? *

Yes

If you are a Ramsey member, would you would you like the EGCC to pay for your survivor wellness class pass?

Yes

No, thank you. I would prefer to pay for my pass.

If you are not a Ramsey member, would you like the EGCC to pay for your membership and survivor wellness class pass?

Yes

No, thank you. I would prefer to pay for my class and membership.

Submit

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms

Forms