Survey - Materials Request Form - English - Lance Armstrong Foundation

LIVESTRONG Materials Request Form

LIVESTRONG offers a set of resources on cancer survivorship that are free of charge and helpful to distribute at your training sessions and to cancer survivors in your community.

The LIVESTRONG Cancer Survivor Packet
This three-piece packet includes a brochure on LIVESTRONG’s Cancer Navigation Services, the What’s Next?, Living After Cancer Treatment brochure and the Cancer Survivor’s Health Journal, which is a helpful tool for cancer survivors to keep track of their cancer-related needs and information.

The materials offered in the Survivor Packet are only available as a three-piece set. This form is for ordering English materials only.
Order Spanish Materials.

Promotores Companion Guide
LIVESTRONG has also created a Companion Guide to the LIVESTRONG Promotores Cancer Survivorship Training. The Companion Guide contains information related to topics covered in the LIVESTRONG Cancer Survivorship Training including:

Cancer and the Hispanic/Latino Community
What is Cancer Survivorship?
What are the Physical Concerns?
What are the Emotional Concerns?
What are the Day-to-Day Concerns?
LIVESTRONG Resources

The Companion Guide is also available free of charge and should be ordered to distribute at your training.

Please allow 10-12 business days for shipping.

* Required Information

National orders are limited to 100 Packets. International Orders are limited to 5 packets.

The Packet for LIVESTRONG Survivors is for individuals looking for information about the survivorship of cancer includes:

LIVESTRONG Cancer Navigation Services Card

What's Next? Brochure

Cancer Survivor's Health Journal

*

Question - Required - Number of packets requested:

Materials for Promotores training only

Companion Guide

Question - Not Required - Number of Companion guides requested:

Contact Information:


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
*	Country: Required
	Phone Number:

Question - Not Required - Organization/Company Name:

*

Question - Required - My relationship with cancer:

*

Question - Required - What type of organization will distribute the materials?:

Question - Not Required - If you belong to another type, what type of organization is it?:

*

Question - Required - Have you distributed these brochures in the past?: Yes
No

*

Question - Required - Are you hosting a Promotores Cancer Survivorship Training?: Yes
No

*

Question - Required - What population do your serve?:

	Cancer Survivors
	Caregivers
	Other

Question - Not Required - If other - what population?:

Question - Not Required - Brochure Distribution Plans:

*

Question - Required - Where did you hear about the Living After Cancer Treatment Series:

	Conference
	Livestrong.org
	LAF event
	Colleague/Friend
	Healthcare provider
	Direct Mailing
	Other

Materials Request Form - English

LIVESTRONG Materials Request Form

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