CanCare Volunteer Application

 


How did you hear about CanCare?

 

Date
  
Name
  
Address
  
City
  
State/Zip
  
Home Phone
  
Work Phone
  
Cell Phone
 
E-mail
  
Birthdate
  
Gender
  
Cancer Survivor?
   Family Member?
Date Diagnosed
  
Type of Cancer  
Metastasis  
Type of Treatment  
Now in Treatment?  

A training fee is set by our Board to show commitment to CanCare and to cover cost of materials and refreshments. They ask that a fee of $25 per person or $40 per couple be paid at the interview. Checks may be made payable to CanCare of Houston, Inc. If this amount is difficult, please let us know. Scholarships are available.

Note: CanCare will not share your personal information with any other agencies.

Download Volunteer Application

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© Copyright 2006, CanCare, Inc.
9575 Katy Freeway, Suite 428, Houston, Texas 77024
713.461.0028 or 1.888.461.0028, Fax 713.461.0704
CanCare, Inc. is a nonprofit 501(c)(3) organization.

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