Membership Application

Membership is open to organizations and individuals whose missions are not in conflict with the Delaware Cancer Consortium (DCC) priorities.

Membership Application

The following are requirements for membership in the DCC. Each member organization agrees to:

  • Endorse and support the implementation of all DCC priorities;
  • Provide annual reports about progress and accomplishments;
  • Coordinate and collaborate within its own organization to implement strategies that address one or more DCC priorities; and/or
  • Coordinate and collaborate with one or more other organizations to implement strategies that address one or more DCC priorities.

Information about your Organization:

Mailing address:

Include any apartment or suite number, if applicable.

The Director, CEO, etc...


Organization Categorization:

Please review the organizational categories listed below. Choose the one category that best describes your organization, even if more than one category applies.

Representative Information:

Below, please provide the name of and contact information for your organization’s designated representative. Because the Consortium is an action-oriented body, it is important that you designate a senior representative with the authority to make decisions and commitments on behalf of your organization.

Mailing address:

Include any apartment or suite number, if applicable.

Interest in DCC Priorities:

Please check the priority/priorities that your organization will address and provide a brief description of your organization’s qualifications to address checked priorities.

Priority Area:

Description of Qualifications:


(cancer registry and registrars; data analysis, interpretation and technical assistance on cancer studies/reports; provides data expertise and technical knowledge to other committees)


(tobacco use prevention; smoking cessation; lifestyle and risk reduction, translate data into information for public use, advocacy, link employers to DCC; healthy homes/occupational health)


(lung, prostate, cervical/HPV, breast and colorectal cancer screening and early detection, translating data into educational information for public use)

Additional comments or instructions?

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