2013 Church Registration

PHEN will carry out its ď5th Annual Fatherís Day Rally Against Prostate CancerĒ in partnership with churches nationwide on Sunday, June 16th, 2013. The Rally takes place within each church through the recognition of, and special prayer for prostate cancer survivors, their family members and the families of those who have been victims of the disease.

PHEN provides ongoing support to its church partners through education and awareness activities and resources which include:

  • Posters for each church to increase prostate cancer knowledge and awareness, and to direct church members to PHENís website for access to online educational resources
  • PHEN TV programs available online, and on DVDís for presentation within churches and other community venues.
  • Speakers and materials for church programs and events
  • Access to PHENís monthly live webcast and online support for newly diagnosed men, survivors and their loved ones.

*There is no cost for participation in the Fatherís Day Rally*

Fields marked with an * are required.
PHEN respects your privacy and will not under any circumstances misuse or share your information.

Name of Church*
Church Denomination*
Pastor*
Address*
City*
State*, Zip*
Website
Email Address*
Phone Number*
Fax Number
Number of Members*
Has your church participated in the Rally before?
Yes     No
If Yes, what year:
PHEN Liaison 1:
Name
Prostate Cancer survivor?
Yes     No
Phone Number
Email Address
PHEN Liaison 2:
Name
Prostate Cancer survivor?
Yes     No
Phone Number
Email Address
Church Facebook Profile
Church Twitter Profile
Comments:






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