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Cancer Connect registration form

Call Cancer Council 13 11 20 or submit the form below to be linked with our Cancer Connect peer-support program.

It's free and confidential.

We have over 100 volunteers throughout Victoria who've had a range of cancer experiences.

Date of birth

Date of birth


CCV’s Privacy Policy and Collection Statement contains general information about how we will collect and handle the personal information contained in this form, including how you request access or correction, or make a complaint.  You should review this Privacy Policy and Collection Statement, to ensure you are fully informed about these matters.

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Questions about cancer?

Call or email our experienced cancer nurses for information and support.

Contact a cancer nurse