Women Physicians
OB/GYN Medical Group
Care of Women by Women
Appointments
Gynecologic Care
Teen Program
Obstetric Care
Newsletters
Provider Profiles
In the News
Vaccinations
Emergencies
Insurance
BOTOX® Therapy
Excessive Sweating
Spider Vein Treatment
Speaker Program
Related Links
Allied Professionals
Directions
Contact Us
Relay for Life

 

           RELAY FOR LIFE  SURVIVOR FORM

The American Cancer Society Relay for Life is an overnight celebration of life dedicated to present and former cancer patients, their families and friends.  Relay for Life raises money for the American Cancer Society while raising awareness that cancer can and will be beaten.

Our goal is to provide the opportunity to EVERY survivor to participate in Relay For Life!  Please fill out the following form to be involved!  All survivors are invited to participate in the inspirational survivor's lap immediately after opening ceremonies at 10:00 am and all survivors who attend will receive a survivor's t-shirt.

 

Event

Mountain View Relay for Life @ Cuesta Park 

Event Date

May 31, 2008

Survivor’s Name

 

Address

 

City, State and Zip

 

Telephone #

 

E-mail addresss (we’d like to be able to stay in occasional contact with our survivors!  We promise not to abuse your e-mail address)

 

Type of Cancer (if you wish to share)

 

Years since Diagnosis (if you wish to share)

 

Can we announce your name?

 

 

Turn in this form to

 

Women Physicians Ob-Gyn Medical Group, a team captain for this event,

at 2485 Hospital Dr., Suite 221, Mountain View, CA 94040 

    

or send to your local American Cancer Society representative, Adriana Caldera

at 747 Camden Ave., Suite B, Campbell, CA 95008

 

 
 
Information on this website is for educational and reference purposes only and should not be interpreted as specific medical advice.
Copyright © 2006
Women Physicians
Ob-Gyn Medical Group

650.988.7550