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UCAN ORGANIZATIONAL MEMBERSHIP FORM
First Name*
Last Name*
Title*
Organization*
Web Address
Mailing Address*
City*
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Fax Number*
E-mail Address*
Overview of UCAN Membership

UCAN members have various levels of participation. All UCAN members will receive semi- monthly newsletters that provide information about upcoming events and UCAN opportunities. All UCAN members are encouraged to attend the quarterly UCAN meetings. Click here for an overview of UCAN member responsibilities.

In addition, there are opportunities to join a work group and/or ad hoc committee.

These committees and work groups are charged with working on strategies identified in the state cancer plan. We ask that members only sign up for work groups and/or committees if they can participate in at least 50% of the meetings.

If you are interested in joining a work group, we will send you additional information after you register. You can join, leave, and/or move between groups and committees at any time.

The form below is for individuals to sign up on behalf of an organization. To sign up as an individual member, please go here.

 

 

Membership level (you can change at any time)

Level 1: Receive email communication and attend quarterly meetings

Level 2: In addition to level 1, participate in a work group or ad hoc committee

Are there particular resources, areas of expertise or educational opportunities you would like to CONTRIBUTE to UCAN?
Are there particular resources, skills or opportunities you would like to RECEIVE as a UCAN member?
Signature (type name)*

By signing this document, I understand that I am a participating member of the Utah Cancer Action Network and endorse the mission of the organization as outlined in the Utah State Cancer Plan.

Date*
 

*Mandatory fields required for submission

 

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