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We welcome members who are not only cancer patients but members of the caring community who believe in the principles of CANSURVIVE. Helping to bring a better service for those in need in the future.
NAME........................................................................................................................
Mrs Mr Ms Miss Dr.
ADDRESS................................................................................................................
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............................................................................... PC ...........................................
PHONE: ..............................…....... .FAX: ...................................
Email:.................................………………….................................
Membership:1 year $35 2 years: $65 .
I wish to make a donation $ ...................... All donations are tax deductible.
DO YOU HAVE CANCER? .....................................................................................
If yes, please give brief details.
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Signed:.............................................................................................
Date:.............................................................................
Please print and send or email this signed form back to CANSURVIVE.
With your payment: Cheque, Money order or Credit Card:
Bankcard Visa Mastercard
Card No:: ………/…..…../…..…../……..…
Expiry date: ………./………...
CANSURVIVE RESEARCH ASSOCIATION Inc.
Offering information and support for those challenged by cancer.  - Supporting You -
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