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Thank you in advance for your interest! All sessions are completely FREE, but please take a few minutes to register below as spots are limited. Note: All information shared here is strictly confidential.
Q.1
Full Name:
*
First Name
Last Name
Q.2
Mobile Number:
*
Phone Number
Q.3
What type of cancer was your partner diagnosed with?
*
Cervical Cancer
Lung Cancer
Ovarian Cancer
Breast Cancer
Other:
Additional Comments:
Q.4
When was your partner diagnosed?
(Month/Year)
Q.5
What is your relationship to her?
*
Husband
Fiancé
Boyfriend
Other:
Q.6
Which session are you interested in signing up for?
*
ضياع ١٠١: بين الحكما والفواتير
وأنا…شو دوري؟
!بس ما تنسا حالك
شو بها الماما؟
الناس وحكي الناس
SEX وبلا SEX
وهلأ لوين؟
Other:
Q.7
How did you find out about the program?
*
A friend or colleague told you.
You received a flyer.
Your partner told you.
Through a doctor or medical professional.
Through social media (Facebook, Instagram, etc.)
Other:
Q.8
What do you hope to benefit from this program?
*
Ask specialists any questions I may have.
Vent or express my thoughts and feelings in a safe space.
Learn more about what my partner is going through and how to help.
Get some tips or recommendations from others.
Meet other men going through a similar experience.
Other:
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