Gilda's Club Lowell LaughFest Grand Rapids Cancer Support Communities

New Interest Form

   

New Member Interest Form

If you are interested in Cancer or Grief Support at Gilda’s Club Grand Rapids or Gilda’s Club Lowell, please complete this form and our Program Staff will contact you with more information within one business day. If you need an immediate response, or you do not receive a response from us, please give us a call at 616-453-8300 or email us at register@gildasclubgr.org.

Thank you for your interest and we look forward to welcoming you soon!

 

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Location Interest

 

Cancer Support Interest

Please complete this section if you are interested in receiving information about our cancer support programs. Leave blank if this does not apply to you (Grief Support info below).


Cancer Support Interest
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Are you interested in bringing a child/teen to our Youth Cancer Support Program?
If yes, what is the child/teen's names and ages?


Please use this space to provide any additional information about your cancer journey:

Cancer Journey

Grief Support Interest

Please complete this section if you are interested in receiving information about our grief support programs. Leave blank if this does not apply to you.


Grief Support Interest
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Who in your life died?
When did it happen?
What was the cause of death? If cancer, what type?
Are you interested in bringing a child/teen to our Children's Grief Program?
If yes, what is the child/teen's names, ages, and who in their life died?

Please use this space to provide any additional information about your grief journey:

Grief Journey