LGBTQ+ Support Group Registration
Fuck Cancer and Young Adult Survivors United are teaming up to launch a new support group for people who identify as LGBTQ+ and are in treatment or post-treatment for cancer. By completing this form, you are indicating your interest in registering for this new support group.

The group will meet via Zoom on the first Tuesday of every month at 5pm PT/8pm ET. The first group will be on May 4, 2021. The group will be facilitated by Tom Pier, LCSW, OSWC, CMF.

Learn more about Fuck Cancer at www.letsfcancer.com.
Learn more about Young Adult Survivors United at www.yasurvivors.org.

If you have any comments or questions about this form, the new support group, or our work, please email hanna@letsfcancer.com.
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First Name *
Last Name *
Street Address *
State/Province *
Zip Code *
Primary Phone Number *
Email Address *
Date of Birth *
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DD
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YYYY
Race
Ethnicity
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Gender
Clear selection
Do you identify as LGBTQ+? *
If you identify as LGBTQ+ and feel comfortable self identifying more specifically, please do so here. Your disclosure will be kept confidential within YASU and Fuck Cancer. It will not be shared with any third-parties and will not be used for any research studies.
Diagnosis *
Diagnosis if "Other"
What is your treatment status? *
Are you able to consistently join a group meeting on the 1st Tuesday of each month at 5pm PT/8pm ET? *
How did you hear about this group? *
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