CLAP Assistance Request Form

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CLAP (Cancer Legacy in Action Projects) assists and encourages individuals (primarily children) who have lost an immediate family member to cancer to carry out projects or actions that extend their loved one's legacy.

We are excited that you are seeking assistance from CLAP to create a legacy project. We just need a little bit of information to get started.

What is your email address? *

Please type your first name: *

Please type your last name: *

Address *

Phone number *

Whose legacy do you wish to honor? *

What is your relationship to the honoree? *

Tell us about your loved one and explain the impact they had in your life. *

What project would you like to undertake to honor the legacy of your loved one?

If you don't have a specific idea to honor your loved one's legacy, would you welcome a call from our team to discuss ideas?

Yes

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Are you at least 18 years old? *

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