Online Individual Membership Application

To apply for Alliance membership, please complete the below form. For questions, contact Heather Hirsch  Hirs0090@umn.edu or 612-624-4099. 

  • As a Minnesota Cancer Alliance (Alliance) member, you will receive membership communications and are responsible for disseminating this information to appropriate colleagues, if applicable.
The mission of the Minnesota Cancer Alliance is to reduce the burden of cancer for all people living in Minnesota, by working together to implement Cancer Plan Minnesota. 
 
Members of the Minnesota Cancer Alliance will:
  • ENDORSE the Minnesota Cancer Alliance mission
  • AGREE to comply with Alliance bylaws
  • AGREE to be identified as an Alliance member in publications, lists or other appropriate contexts
  • AGREE to support and participate in Alliance evaluation efforts
Name 
Address 
City 
State 
Zip Code  
Phone Number  
Fax Number  
Email