New Member Interest Form

  • Please complete this form if you are interested in Cancer or Grief Support at Gilda's Club Grand Rapids or Gilda's Club Lowell. A member of our program staff will contact you with more information. If you have any questions please call us at 616-453-8300, toll free at 1-800-326-1419, or email us at register@gildasclubgr.org.
  • Cancer Support Interest

    Please complete this section if you are interested in receiving information about our cancer support programs. Leave blank if this does not apply to you (Grief Support info below).
  • Grief Support Interest

    Please complete this section if you are interested in receiving information about our grief support programs. Leave blank if this does not apply to you.