Connect with a Survivor and Caregiver Network volunteer

Please complete the information below to be matched with volunteers in the Survivor and Caregiver Network.

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*First name:
*Last name:
*Phone:
E-mail:
Preferred Method of Contact:
 Phone Email
Age:
State of Residence:

*Your relationship with pancreatic cancer:
 Patient/Survivor Caregiver/Family member/Friend

Type of Pancreatic Cancer :

Stage of Pancreatic Cancer:

Treatment History:

Type the characters you see in the picture:

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Information provided by the Pancreatic Cancer Action Network, Inc. (“PanCAN”) is not a substitute for medical advice, diagnosis, treatment or other health care services. PanCAN may provide information to you about physicians, products, services, clinical trials or treatments related to pancreatic cancer, but PanCAN does not recommend nor endorse any particular health care resource. In addition, please note that any personal information you provide to PanCAN’s associates during telephone and/or email communications may be stored and used to help PanCAN achieve its mission of assisting patients with, and finding cures and treatments for, pancreatic cancer. Stored constituent information may be used to inform PanCAN programs and activities. Information also may be provided in aggregate or limited formats to third parties to guide future pancreatic cancer research and treatment efforts. PanCAN will not provide personal directly identifying information (such as your name or contact information) to such third parties without your prior written consent unless required or permitted by law to do so.