Participant Registration

Step 1
Step 2
About You
Step 3

Welcome to Cancer Support Community Arizona (CSCAZ)! We are glad you were able to connect with us for social and emotional support. This questionnaire will ask you various demographic questions that allows CSCAZ to participate in research, grants, and additional funding opportunities to continue providing FREE support to you! Everything you share is strictly confidential. Your responses will in no way influence your participation in the programs. The fields marked with an asterisk (*) are required in order to register for programming at CSCAZ.

Personal Information    
First Name *  
Middle Name
Last Name *  Suffix
Preferred Name 
Home Address *
City *
State *
Zip *
Country *
Email *
Home Phone *
Work Phone
Cell Phone
I agree to receive text messages at this number.
Date of Birth *
Gender *
Password (Confirm)

Email and text message communications from Cancer Support Community Arizona are generally focused on - but not limited to - supporting you with the programs we offer and reminders to attend programs you have registered for. On average, you can expect to receive 2-3 email messages per week and one text per program registration. Depending on your phone plan, message and data rates may apply to receiving text messages.

To opt-out of receiving specific messages, please choose the "Communications Preferences" option from your web portal account after logging in. To stop receiving all text messages from us, you may reply "STOP" to any text message that you receive. For assistance with any messaging-related support, please contact us on T: (602) 712-1006 ~ F: (602) 712-1009.  Our full privacy policy may be reviewed here.