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Global Leader Sign-Up

Thank you for taking the time to register to become a LIVESTRONG Leader. Please complete the form below to receive access to additional tools and information to assist you in raising awareness and involving your friends, family and community in the fight against cancer.

Important: If you choose to name your group, please use the Leader Search function to search for other leaders in your are and make sure you don't duplicate an already established group name. 

Also, please refrain from using LIVESTRONG™ in the name of your group.  LIVESTRONG is a trademark of the Lance Armstrong Foundation and may not be used in conjunction with any other product, service, or event not approved by the Lance Armstrong Foundation. A few examples of group names: using the name of your city or neighborhood, Austin Cancer Fighters, London Cancer Survivors, Beat Cancer!.

Once the form is submitted, you will receive an email within 24 hours with helpful tools and resources to help you get started. As a leader, you can take on projects both big and small. Being a LIVESTRONG Leader is a fun and effective way to make a difference. Together, we can work to make cancer a global priority. If you have any questions, please contact us at grassroots@livestrong.org.

Already Registered? Click here to autofill this form
* required information
 
First Name:*
Last Name:*
Birth Date:*(mm/dd/yyyy)
Email:*
Gender:* Female   Male  
Phone:*
Address Line 1:*
Address Line 2:
City:*
State:*
Province:
ZIP/Postal Code:*
Country:*
Please select the racial and ethnic category or categories with which you most closely identify. Select all that apply: African-American/Black
American Indian/Alaska Native
Asian
Caucasian/White
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Other
I prefer not to respond
My Connection to Cancer:* I have or had cancer
Family member or Spouse or Partner
Caregiver
Friend or loved one
Healthcare provider
Health professional
Know someone with cancer
No connection
I prefer not to respond
Other
Please briefly describe your experience with cancer and/or the cancer community:
What is the goal of your group?:
What would you like the name of your group to be (ex: Austin, Cancer Fighters):
Create Username and Password
Username:*
Password:*
Verify password:*
Security Question:
Security Answer:*
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By submitting this form, I permit the Lance Armstrong Foundation to publish my name, email, and the goal of my group on the Leader Search on their website. I understand that the information I've provided will be made public and my e-mail address may be accessed by interested parties.
        
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