Georgia Virtual Blood Cancer Support Group (with Mark) Registration

Please have each patient, caregiver, family member or friend
who will be attending register individually.

With which race(s) do you identify? (Select all that apply) *
Do you identify as Hispanic, Latino or Spanish origin? *
Please specify your gender. *
Have you ever served on active duty in the U.S. Armed Forces, Military Reserves, or National Guard? *
Do you have questions about your disease, treatment or resources and would like a call from an LLS Information Specialist to discuss them? *