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West Texas Cancer Survivors Network

WTCSN Enrollment Form

Please Read:

  1. I understand that this enrollment form will ask me to provide the following information:
    • Personal Contact Information
    • Cancer History
    • Demographic Information
  2. I also understand that the information I provide will be kept private and accessed only by WTCSN staff members.
  3. I understand that I can discontinue completing this enrollment form at any time.

Yes, I understand the statements above and want to continue on to the WTCSN Enrollment Form! Click on the "Enroll" button below to continue.

I want to skip the enrollment entirely and go back to the CNNT Home Page.

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