Navigate Cancer Foundation :: Account Registration

Please complete the short registration to begin your secure communication with us. Any information provided is kept strictly confidential. All services are free of charge. If you would prefer to talk with someone by phone, please contact us Monday-Friday 9am - 5pm EST at 866.391.1121.

All fields required unless otherwise noted.

Account type:
Please select an Account type:*
 

Login information:
Choose a Username:
 
Choose a Password:
 
Re-enter Password:
 
Passwords must be at least 6 characters long and contain at least 1 number

Your Contact information:
First Name:
 
Last Name:
 
Birth Year:
 
Gender:
 
Address:
 
City:
 
State:
 
Zip/Postal:
 
Home Phone (optional):
 
Mobile Phone (optional):
 
Work Phone (optional):
 
Email Address:
 
Confirm Email Address:
 
 
How did you find us?
 

Your Account information:
Race:
  Native American Asian Biracial African-American Hispanic Caucasian
  Other
Type of Cancer: (Breast, Colon, Lymphoma, Prostate, etc.)
 
Date diagnosed: (mm/yyyy)
  /
Stage of Cancer:
 
You must read and click that you have read the Terms of Use and Notice of Privacy Practice before
you can continue with registration

Terms of Use:*
  I have read and understand the terms of use and Notice of Privacy Practice for this website.
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1 Patient and/or Participant must be at least 18 years of age in 4 digit fomrat (YYYY)
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- Click here to view our Notice of Privacy Practice