JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
BRECAN ABUJA CHAPTER WCD Walk Against Cancer Registration Form
February 4th is marked globally as the world cancer day. In Abuja, BRECAN has concluded arrangements to mark the day with a walk against cancer . We hope to use this event to raise cancer awareness as well as relaunch the Abuja chapter of BRECAN.
Route:
Start: Force Heaquarters
End : Obum Place, 16 Ademola Adetokunbo Crescent, Wuse 2, Abuja.
Time: 8:00 prompt
Tel: +234 803 700 4068
For payments:
United Bank UBA
Account no:1020353769
Breast Cancer Association of Nigeria
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Option 1
Clear selection
Full name
*
Your answer
Phone number
*
Your answer
Gender
*
male
Female
Age
*
below 18
18-25 years
25- 50 years
above 50 years
Occupation
*
Student
Civil servant
Private sector
Artisan
others
Are you a registered member of BRECAN?
*
Yes
No
If yes, which chapter
Oyo
Ondo
Lagos
Bayelsa
Imo
Abuja
Clear selection
Will you be participating in the walk?
*
Yes
No
undecided
If you will be participating in the walk, please confirm your shirt size:
Round-neck: 3,000
Polo:4,000
Cap:3,000
S
M
L
XL
XXL
Clear selection
If you are not a member of BRECAN, Which organization do you belong to?
*
Your answer
Would you like to join BRECAN after this walk?
Yes
No
not sure
Clear selection
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms