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Home Page Please send the newsletter "CONVERSATIONS!" on a regular basis.
Send it: ______ Once MONTHLY (every issue)
It is OK to print my: ______ full name and state ______ first name only and state
| _____Yes ____ No | Do you belong to a support group of any kind (couples, women's cancer, gyn cancer, etc). Please send me the leader's name, address, and phone number and other information about the group so that I can tell others about the group. |
| IF "YES" -Please use the area below to enter support group
information: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ |
Matching service: If you are interested in talking to others who might have similar interests or circumstances, there is a pen pal/phone pal matching services called "VOICES". An example of how this works: Let's say you are 35 and have 3 young children and you want to talk with someone else who also has young children, then we can give you their name. Other reasons people want to connect are: age at diagnosis, stage at diagnosis, unusual cell type, unusual chemo drug or treatment, other health conditions such as diabetes or colostomies, family history of cancer, etc. Matches are based upon known information about you and others. Please be sure your info is correct and current for best possible matches. Matches are made upon request. |
| _____Yes ____ No | It is OK to give other fighters of ovarian cancer my name (address, phone, e-mail, etc) for more direct, and faster, contact when they have information which might be helpful to me or when I can possibly help them. |
PERSONAL INFORMATION
First Name:________________________ Last Name:______________________________
Company:_________________________ Title:____________________________________
Date of Birth: (mm/dd/yy)____________ Marital Status:____________________________
Company Address:____________________________________ Send there?: ____________
Street Address:_______________________________________ Country:______________
City:________________________________ State:______ Postal Code:_______________
Home Phone: (area code first)__________________________________________________
Work Phone: (area code first)__________________________________________________
Fax Phone: (area code first)____________________________________________________
E-Mail Address:_____________________________________________________________
Web Site Address:___________________________________________________________
Date of Diagnosis: (mm/dd/yy)________________ Stage:____________________________
Cell Type:___________________________________________________________________
Please use the area on back to comment about your family, medical history, hobbies, etc.
Then mail to:
“CONVERSATIONS!” P.O. Box 7948, Amarillo, TX 79114-7948 (806) 355-2565
Updated: Wednesday, August 08, 2007 01:18:29 AM
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