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Update Your Listing

Your listing is very important to us. First we want to accurately list support group with current information, and Second, we need your current information so we can contact you, be it surface postal mail, EMAIL, phone or fax and third, is when patients, especially newly diagnosed patients, are looking for a support group in their area.

The detail information of the contact person is strictly confidential - used by CPCC only to contact you.

TO UPDATE YOUR LISTING FOR THE
SUPPORT GROUP DATA BASE:

Please complete the following form and click Submit;
(text boxes have unlimited space)

Name:
Example (Prostate Cancer Support Group)
Day and Time of Meeting:
Example (Second Tuesday 7 - 9PM)
 Location Name:
Example (ACS Board Room)
 Physical location:
Example (2942 "F" Street)
 City:
Example (Eureka)
Zip:
Example (95503)
Name of contact person(s):
Example (Stan Mikkelsen)
 Street address:
Example (4145 Excelsior Rd)
City:
Example (Eureka)
Zip:
Example (95503)
Phone:
Example (707-442-3922)
Fax:
Example (707-442-1509)
Email:
Example (swmcpcc@aol.com)
Affiliation:
Example (UsToo - Man to Man)
Additional Comments:

Option, instead of clicking submit, you may print and fax or mail it to us. Please send the above information listed to:

     Stan Mikkelsen:
     email: swmcpcc@aol.com
     Phone: 707-442-3922
     Fax: 707-442-1509
     Postal Mail: 4145 Excelsior Rd., Eureka, CA 95503

Your listing will appear as i.e.:

REDWOOD REGION
Eureka
Humboldt County PCSG
Second Tuesday 7 - 9PM
ACS Board Room
2942 "F" Street
Stan Mikkelsen 707-442-3922