Join the National Lung Cancer Support Group Network Form

Join the National Lung Cancer Support Group Network

Support group name

If your group is affiliated with a cancer center or nonprofit, please provide the organization’s name

Support group meeting format

Address – street

Address – city

Address - state

Zip code

First name*

Last name*

Email*

Phone

Is the group facilitator different from the primary contact?*

Facilitator First Name

Facilitator Last Name

Please check all boxes that apply so that we can best support you.

I have a lung cancer support group, but need guidance on challenges I am facing with the group.

I have a group and would like to join the network for additional referrals and support.

I would like someone from GO2 for Lung Cancer to contact me.

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