LGBTQIA+ Support Group Registration
Fuck Cancer and Young Adult Survivors United (YASU) are collaboratively offering a support group for adults (ages 18+) who identify as LGBTQIA+ and are in treatment or post-treatment for cancer. By completing this form, you are indicating your interest in registering for this support group.

The following questions remain confidential to the facilitator, two YASU staff members, and one Fuck Cancer staff member. No personal information is ever shared publicly. This information is only shared with the facilitator so he can email the Zoom link to individuals who complete this form, prior to each support group.

The group meets via Zoom on the first Tuesday of every month at 5pm PT/8pm ET. The group is facilitated by Joshua Bechdel, MS, LPC.

Learn more about Fuck Cancer at www.letsfcancer.com.
Learn more about Young Adult Survivors United at www.yasurvivors.org.

If you have any comments or questions about this form, the new support group, or our work, please email Hanna at Fuck Cancer (hanna@letsfcancer.com) or Stephanie at YASU (stephanie@yasurvivors.org).
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First Name *
Last Name *
State/Province *
Zip Code *
Primary Phone Number *
Email Address *
What is your age range? *
Race
Ethnicity
Clear selection
Gender
Clear selection
Do you identify as LGBTQIA+? *
If you identify as LGBTQIA+ and feel comfortable self identifying more specifically, please do so here. Your disclosure will be kept confidential within YASU and Fuck Cancer. It will not be shared with any third-parties and will not be used for any research studies.
Diagnosis *
Diagnosis if "Other"
What is your treatment status? *
How did you hear about this group? *
Required
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