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* 1. Organization Information

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* 2. Main Contact Information

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* 3. Executive Director

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* 4. Organization Mission Statement

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* 5. Total Membership (#)

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* 6. Please describe any credentialing or accreditation activities (if applicable).

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* 7. Names and titles of current officers:

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* 8. Please describe why your organization is seeking membership on the CoC, including specific examples of how your organization can add value to the CoC:

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* 9. Please describe how CoC membership will benefit your organization.

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* 10. Please confirm that your organization is national in scope and serves a national membership.

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* 11. Please describe how your organization actively addresses equity, diversity, and inclusion in cancer care.

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* 12. Please indicate the organization’s primary areas of involvement in the field of oncology and on Question 13 describe how your organization supports these related Commission on Cancer standards (check all that apply).

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* 13. Please describe how your organization supports these related Commission on Cancer standards. 

If selected for membership, please evaluate your organization and its appointed representative’s ability to meet the following core expectations.
  • Serve a minimum, three-year term
  • Serve on, and actively participate in, a CoC standing committee
  • Attend, and actively participate in, at least one in-person meeting a year, which include the appointed committee and member organization representatives meeting
  • Financially support your representative’s travel and lodging to the in-person meetings
  • Report on CoC activities annually to your organization’s leadership and constituents
  • Contribute content about your organization’s activities to the Cancer Programs News newsletter

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* 14. Please attach your letter of interest in .PDF or .DOC, .DOCX format. 

PDF, DOC, DOCX file types only.
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* 15. Information of individual completing this application (if different from main contact person). 

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* 16. Any additional supporting materials may be attached in this section.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 17. Please enter your eSignature below:

For questions, please contact Victoria Hernandez, Cancer Programs Administrator, at cpmembership@facs.org or via phone (312) 202-5209.

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