African American Fellowship Sign Up
Connect with others impacted by cancer in our monthly African American Fellowship meeting on the second Thursday of every month from 6-8 p.m. on Zoom. This free, professionally-facilitated group welcomes all patients, survivors, and loved ones (including those who have lost a loved one to cancer) identifying as Black or African American. We hope you'll join us!

Please fill out the form below with your contact information and a member of our staff will be in touch shortly with login information.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Phone Number *
Email Address *
Date of Birth *
MM
/
DD
/
YYYY
What is your connection to cancer?
Cancer Type
Virtual Programs Confidentiality and Safety
I agree to CSC's confidentiality and safety policy. *
Required
Have you attended a CSC program before? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Cancer Support Community of Greater Ann Arbor.

Does this form look suspicious? Report