Membership & Workgroup Renewal Form 2022-2024

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Please complete this form to continue participation on the California Dialogue on Cancer (CDOC) Workgroup(s) listed below.

This recommitment applies to the following time frame: January 30, 2022 - January 30, 2024

Please review the CDOC Stakeholder and Workgroup Guidelines.

I have read and understand the CDOC Stakeholder Membership Guidelines. *

Yes

Required

Please review the CDOC Workgroup Guidelines.

I read and understand the CDOC Workgroup Membership Guidelines. *

Yes, I understand my responsibilities as a workgroup member

No, I do not wish to be part of a workgroup

I wish to continue my membership with CDOC and understand the terms listed in the workgroup expectations above. I would like to continue my commitment on the following Workgroup(s): (Check all that Apply) *

Colorectal Cancer

Survivorship

Health Equity

Executive Committee

I am not able to commit to a workgroup at this time

I would like more information before committing to a workgroup

Required

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