Membership Information Request

If you would like to join Gilda’s Club NYC, please complete the form below and someone from our
Program Staff will contact you shortly to discuss the virtual membership process.

Name*
First Last
Email*
Phone*
Please check all of the following that currently apply to you*
- I am actively living with a cancer diagnosis.
- I am Post-Treatment (PT) from cancer within 5 years.
- I am grieving the death of a loved one from cancer within 5 years.
- I am actively caring for a person living with cancer.
- None of the above are applicable.
Are you an active member of a Cancer Support Community/Gilda’s Club affiliate outside of NYC? If yes, please note affiliate name and location (if not please note N/A)*
After you complete this request, you will receive a call from the Program Staff to follow-up regarding your customized membership process. Please note the best day/time to contact you.*

At Gilda’s Club NYC, we believe no one should face cancer alone!

Membership Information Request

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