Membership

The Pennsylvania Cancer Coalition (PCC) invites individuals and organizations to join in the fight to reduce the burden of cancer in Pennsylvania. While there is no cost to the member or organization, members are expected to:

• Work within each member’s own organization and with outside organizations to implement Cancer Plan goals and strategies.
• Lend their expertise to one or more of the PCC Workgroups or Subcommittees.
• Attend quarterly PCC meetings to share ideas and Cancer Plan implementation strategies.
• Provide annual Healthy Living Practices and report on cancer plan activities.
• Engage in measurable cancer prevention and control activities in Pennsylvania.
• Participate in the annual membership satisfaction survey regarding PCC activities.
• Update membership information.

For additional information contact This email address is being protected from spambots. You need JavaScript enabled to view it..

Member Registration Form

Please complete all required fields!

You can either enroll online or submit the PDF form. If you prefer to complete a hardcopy of the Membership Form, please download it and email the completed form as an attachment to This email address is being protected from spambots. You need JavaScript enabled to view it. with the subject “New Membership”.

Contact Information:

First Name:(*)

Invalid input.

MI:

Invalid Input

Last Name:(*)

Invalid Input

E-mail(*)

Please provide a valid e-mail!

Verify E-mail(*)

Retype the e-mail!

Credentials:

Invalid Input

Organization:

Invalid Input

Address:

Invalid Input

Rm/Floor/Suite:

Invalid Input

City:(*)

Invalid Input

State:(*)

Please select...ALABAMAALASKAAMERICAN SAMOAARIZONAARKANSASCALIFORNIACOLORADOCONNECTICUTDELAWAREDISTRICT OF COLUMBIAFEDERATED STATES OF MICRONESIAFLORIDAGEORGIAGUAM GUHAWAIIIDAHOILLINOISINDIANAIOWAKANSASKENTUCKYLOUISIANAMAINEMARSHALL ISLANDSMARYLANDMASSACHUSETTSMICHIGANMINNESOTAMISSISSIPPIMISSOURIMONTANANEBRASKANEVADANEW HAMPSHIRENEW JERSEYNEW MEXICONEW YORKNORTH CAROLINANORTH DAKOTANORTHERN MARIANA ISLANDSOHIOOKLAHOMAOREGONPALAUPENNSYLVANIAPUERTO RICORHODE ISLANDSOUTH CAROLINASOUTH DAKOTATENNESSEETEXASUTAHVERMONTVIRGIN ISLANDSVIRGINIAWASHINGTONWEST VIRGINIAWISCONSINWYOMING Invalid Input

Zipcode:(*)

Invalid Input

Phone:(*)

Invalid Input

Cell Phone (Optional):

Invalid Input

PCC Workgroup or Subcommittee:
Please check one Workgroup or Subcommittee you are interested in from the following options.

Subcommittee

CommunicationsDisparitiesEvaluationMembershipPolicy Invalid Input

Primary Prevention Workgroup

HPV-relatedLung Health Invalid Input

Screening & Early Detection Workgroups

Colorectal CancerMen's Health Invalid Input

Diagnosis & Treatment Workgroup

Cancer Genetics Invalid Input

Quality of Life Workgroup

Survivorship Invalid Input

Organization: Please indicate which best describes your organization.

Organization Type:(*)

Academic Institution

Business/Industry Community Based Organization

Community Health Center/FQHC

Elected/Appointed Official

Faith-based Organization

Foundation/Philanthropic

Government Organization

Local

State

Federal

Health Care Organization (inc. Health Systems)

Health Insurance Company

Health Care Professional

Non-Profit Organization

Professional Association

Other

You must make a selection.

My name and organization may be listed in the membership roster for the Pennsylvania Cancer Coalition shown on LivehealthyPA.com and PACancerCoalition.org. My information will not be shared with third parties for solicitation purposes.

I have read the above statement, and:(*)

I agree my name may be listed

Do not include my name and organization

You must choose one before submitting this form.

Enter the text...(*)

Refresh the characters Invalid Input