National Cancer Survivors Day 2014 Sunday June 1st 1pm - 4pm

Kaiser Permanente Anaheim Medical Center

3440 East La Palma Avenue, Anaheim 92806

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* 1. First Name

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* 2. Last Name

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* 3. How many people will be attending including yourself?

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* 4. Type of Cancer?

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* 5. How many years after treatment?

0 years, still in treatment

Less than 1 year

1-5 years

6-10 years

11-15 years

16 years or longer

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* 6. To help us with our planning purposes, please indicate the age of the cancer survivor.

1-5

6-10

11-18

19-50

51-65

66 and above.

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* 7. If you were treated at the Orange County Kaiser Oncology department, please share with us the name of your Oncologist and/or Surgeon

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* 8. Please let us know how you heard about our event? (Please click all that apply)

During my appointment

I saw a posterboard at the medical center

I was given a flyer at the medical center

Word of mouth

I attended last year

Susan B Komen web-site

National Cancer Survivor web-site

Other (please specify)

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* 9. What words of encouragement would you like to share with other cancer survivors?

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* 10. If you would like a reminder a few days prior to the event, please enter your email here. Email addresses will be used for no other purpose, nor shared with any other source.

Learn, Enjoy and Be Inspired with our special activities planned for the day.
-Cooking Demos
-Vendors
-Farmers Market
-Informative Seminars
-Guide Tour of the Infusion Center
-Summertime Treats