Mary Rita's Cancer Thriver Fund Application

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Please fill out the following information to apply for Let Every Woman Know financial support for Alaskans diagnosed with gynecologic cancer. The Mary Rita’s Cancer Thriver Fund is for Alaskans impacted by gynecologic cancer requesting financial aid, and is limited to $500 per individual each year.
The $500 awarded may be used to cover treatment and copays for traditional and integrative medical care, travel, lodging costs associated with cancer treatment.

First and Last Name

Patient's Email Address + Phone Number

Type + Stage of Cancer

Purpose of Funds

Mailing address to receive check payment

By typing your name below, you certify and submit that the recipient of this grant is a resident of the State of Alaska and that the data submitted is correct.

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