Smith Center One-Day Cancer Retreat Application

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Please be assured that your responses will be kept in the strictest confidence. By answering the following questions, you help us get to know you and alert us to any physical activities that may be a concern for you.

**Please note this form does not allow you to save your progress, so we recommend completing in one sitting or writing your answers in a word document and pasting them into this form below.

Email *

Are you applying to attend the "What's Important Now?" One Day Retreat on Saturday, January 25, 2019? *

Yes

Have you completed or are you within two months of completing primary cancer treatment (excluding hormonal therapies)? *

Yes

If you answered NO to the previous question, but still feel this program would be helpful to you, please explain below:

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