2018 Shine a Light Healthcare Facility Letter of Agreement

Thank you for joining the Shine a Light on Lung Cancer movement! This is your official agreement to host a Shine a Light event this November. Once you complete and submit the following information, you will receive a confirmation e-mail with all of the tools and resources necessary for your event. Please note, if you are hosting more than one Shine a Light event, you will need to submit one form for each event. Thank you!

 

To confirm your Shine a Light on Lung Cancer event, please review and agree to the following:

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YOUR CONTACT INFORMATION

Please note that the following information is used for your event listing on our Shine a Light on Lung Cancer website. Please enter the information with proper capitalization and check spelling and accuracy. Thank you!  

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  Enter your contact information:

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Name:

 

 

 

     

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EVENT REGISTRATION

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Question - Required - Event Date:




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SHINE A LIGHT KIT MAILING INFORMATION

 

Enter the mailing address for the Shine a Light Kit:

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If you have any questions, please contact Elizabeth by email at espangler@lungcanceralliance.org or by phone at 202-742-1893.

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