Never Too Young Taskforce Application

Information

First name

Last name

Mobile Number

Address

Street

City

State

Zip code

Interest and experience

Do you volunteer with the Alliance?

Yes, I have been active in the last year.Yes, but I haven't been active in the last year. No, I've never volunteered for the Alliance.Yes, I'm an active member of N2Y Taskforce.Yes, I'm an active Alumni member.

How have you been volunteering?

Any other service you want to share that you have been doing to impact young-onset colorectal cancer?

In what type of media are you comfortable appearing?

TVRadioPrint media (newspaper, magazine, etc.)

Do you have regular access to the following? (Check all that apply.)

ComputerE-mailInternetSmartphone

The Alliance assigns each Never Too Young Taskforce Member to a subcommittee based on experience, interests and organizational needs.

Let us know where you think you would best contribute by ranking our subcommittees from 1 (favorite) to 3 (least favorite).

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Screen (awareness and prevention)

	1
Alumni (N2Y leadership role must serve on board 1 year to be eligible)

Please tell us the reason for your first choice.

Your other affiliations

Have you been featured by any cancer organizations, including ours? (This wouldn't necessarily prevent you from being selected, but we are hoping to highlight some allies who have not shared their story before!)

YesNo

Which organizations did you represent?

When?

How were you featured?

Commitments

Monthly service and participation is required as a Never Too Young Taskforce Member. How many hours a month can you commit to this service?

This particular opportunity may introduce a conflict of interest for allies who are leaders with multiple organizations simultaneously. If selected, would you make a one-year commitment to use your story to raise funds and awareness of CRC for the Alliance exclusively?

YesNo

Can you make the following N2Y commitments: Fundraising two times a year, acting as a moderator in Ally to Ally, representing the Alliance at National conferences and attending in-services at the Alliance?

YesNo

Yes, I want to receive email updates from the Colorectal Cancer Alliance.

Yes, I want to receive periodic text updates from the Colorectal Cancer Alliance. Message and data rates may apply. Text STOP to opt out, HELP for info. Privacy Policy.

I attest that everything I have shared in this application is true. I understand that discovery of fraud in this application is grounds for immediate removal from the program. I also understand that, if selected, I will make a one-year commitment to raise funds and colorectal cancer awareness for the Alliance and will sign a release agreement.

Contact Information

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Care (support to patients, caregivers and survivors)
Cure (scientific committee)