It's easy to start a kidney cancer support meeting!

Name:			City:
Address:			State:	(or Province)
Phone:	Extension:		Email:
I'm a:		Describe if "other:"
I want:			Date:	Enter some possible meeting dates:
	Check the following only if you selected "educational meeting" above:
	I am already working with a possible speaker
	I need help finding a speaker
	I need help finding a meeting location (public libraries and hospitals are possibilities)
	I know of a possible meeting location; please contact me
	Add your remarks, if any, here:

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