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CLF-DC RSVP - 2017

CLF-DC Patient Networking Event

The Cutaneous Lymphoma Foundation invites you to join us at our DC Patient Networking event.

Location: Life With Cancer Family Center
Address: 8411 Pennell St, Fairfax, VA
Directions can be found on the website: www.lifewithcancer.org

Schedule: Monthly Meetings
First Wednesdays, from 7:00 - 9:00 pm of odd calendar months
Second Saturdays, from 10 am - 12 pm of even calendar months.

To RSVP, please fill out the following survey and submit.

1. Please select the meeting date: *This question is required.

2. I am...

3. Contact Information:

First Name *This question is required.

Last Name *This question is required.

Street Address

City

State

Postal Code

Email Address *This question is required. This question requires a valid email address.

Home Phone

Mobile Phone

May we share your contact information with the group leader/s? *This question is required.

Guest Name

Relationship

4. Will you be attending the DC patient networking event? *This question is required.

Yes, I will be attending.
No, I am unable to attend.

5. Do you give the CLF permission to use any pictures of you that may be taken with our group? Photos may be used for CLF's printed publications, website or Facebook page and individuals may or may not be identified. (Response Required) *This question is required.

6. If you are not able to attend this event, would you be interested in future patient networking events?

Yes, please notify me of future events.
No, I am not interested in patient networking events.

7. Comments:

8. Would you like to receive our e-newsletter to keep up on our news, updates, and tips?

Yes, send me news and updates. (We respect your privacy and will not send unsolicited email.)