The Cancer Warriors

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Become a Warrior

If you are a cancer patient currently fighting your battle against cancer or have a friend or loved one that is, please fill out the following forms with the PATIENT'S information. We will use this information to add the patient to our registry and minister to them with love, encouragement, and prayers. God Bless.

First Name:

Last Name:

Male: Female:

Street Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Email:

Date of Birth:

Cancer Type

T-Shirt Size: S M L XL 2XL 3XL

May we share your information with our CWSO Team Members? Y N

May our Team Members do the following:
Call you? Y N Email you? Y N Visit you? Y N

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