New Hampshire Breast Cancer Coalition

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Membership Form

New Hampshire residents, please use this form to join NHBCC and help us end breast cancer.

Out-of-state residents, please visit the National Breast Cancer Coalition to join the national legislative alert network and find a breast cancer advocacy organization to join in your state.

Membership Information

		I am a New Hampshire resident or organization. I would like to become an NHBCC member.

		I am a New Hampshire resident or organization. Please add me to your mailing list to receive NHBCC news.

		I am willing to help on New Hampshire-based NHBCC projects or committees.

		I am willing to write or call legislators and policymakers on New Hampshire-based breast cancer issues. Please add my name to the NHBCC Action Alert Network.

		I am associated with a New Hampshire-based physician, clinic or hospital. Please send me copies of NHBCC's newsletter, "Raising Our Voices", for professionals and patients in our waiting room.

		How many copies would you like? (Suggested donation, $100.)
		25 50 75 100 Other

		I would like to make a donation to NHBCC in the amount of:
		$20 $50 $100 $250
		Special Occasion Memorial gift
		Other

Contact Information

* required

First Name *
Last Name *
Organization
Address *
Address
City *
State *
Zip Code *
Day Phone *
Evening Phone
E-mail *

Comments/Requests

Please make checks payable to: New Hampshire Breast Cancer Coalition, and mail to: NHBCC, 18 Belle Lane, Lee, NH 03861-6438. NHBCC is an all-volunteer 501(c)(3) organization. Donations are tax deductible as permitted by law.

For more information about becoming a member or volunteer, or making a donation, call Nancy Ryan at: 603.650.3482 or E-mail us using our Contact Form.

Photo: From L to R: NHBCC Steering Committee members Sue Holmes and Jane Edmunds with Carolyn Morris (United Kingdom) at the NBCC Advocacy Training Conference, Washington, DC, May 2004.

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18 Belle Lane, Lee, NH 03861-6438 • Phone: 603.659.3482 • Contact Form