ZERO Advocacy Leaders Program Application Are you interested in taking your prostate cancer advocacy to the next level? Do you want to learn how to become a more effective advocate both in Washington and at home? We are building a team of committed advocates to hone into leaders in the prostate cancer community. To be considered for the Advocacy Leaders Program class of '26-'27, please complete the form below. The deadline to complete this form is September 1st, 2026. Participants will be notified by September 11th, with the first meeting in the week of October 6th.If you have any questions, please email hal@zerocancer.org Name First Last Email Phone Address Street Address Street Line 2 City/Town State/Province - None -AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPuerto RicoPalauVirgin IslandsArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces PacificBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code How many ZERO Advocacy Summits have you attended? - Select -NoneOneTwoThreeFour or more What is your connection to prostate cancer? - Select -Prostate cancer patient/survivorCaregiverFamily member of prostate cancer patient/survivorFriend of prostate cancer patient/survivorFamily member of a love done lost to prostate cancerFriend of someone lost to prostate cancerMedical professionalI have no connection to prostate cancer Are you Hispanic, Latino/a, or of Spanish origin? - Select -No, not of Hispanic, Latino/a, or Spanish originYes, Mexican, Mexican American, or Chicano/aYes, Puerto RicanYes, CubanYes, Another Hispanic, Latino/a, or Spanish originPrefer not to answer Which of the following best describes you? - Select -American Indian or Alaska NativeAsianBlack or African AmericanMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderWhiteAnother racePrefer not to answer Are you a Veteran or active duty military? Yes No Prefer not to answer Please provide a detailed explanation of why you think you would be a good candidate for the Summit Leaders Program, and how you will use your prostate cancer story to help others. By submitting this application, I confirm that the information provided is accurate and truthful to the best of my knowledge. Yes I understand that selection for the Advocacy Leaders Program requires full participation in all related programming, which includes eight virtual seminars in the coming fall/winter and the 2027 Summit from February 21-23 in Washington, DC. Yes
To be considered for the Advocacy Leaders Program class of '26-'27, please complete the form below. The deadline to complete this form is September 1st, 2026. Participants will be notified by September 11th, with the first meeting in the week of October 6th.If you have any questions, please email hal@zerocancer.org
Name First Last Email Phone Address Street Address Street Line 2 City/Town State/Province - None -AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPuerto RicoPalauVirgin IslandsArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces PacificBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code How many ZERO Advocacy Summits have you attended? - Select -NoneOneTwoThreeFour or more What is your connection to prostate cancer? - Select -Prostate cancer patient/survivorCaregiverFamily member of prostate cancer patient/survivorFriend of prostate cancer patient/survivorFamily member of a love done lost to prostate cancerFriend of someone lost to prostate cancerMedical professionalI have no connection to prostate cancer Are you Hispanic, Latino/a, or of Spanish origin? - Select -No, not of Hispanic, Latino/a, or Spanish originYes, Mexican, Mexican American, or Chicano/aYes, Puerto RicanYes, CubanYes, Another Hispanic, Latino/a, or Spanish originPrefer not to answer Which of the following best describes you? - Select -American Indian or Alaska NativeAsianBlack or African AmericanMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderWhiteAnother racePrefer not to answer Are you a Veteran or active duty military? Yes No Prefer not to answer Please provide a detailed explanation of why you think you would be a good candidate for the Summit Leaders Program, and how you will use your prostate cancer story to help others. By submitting this application, I confirm that the information provided is accurate and truthful to the best of my knowledge. Yes I understand that selection for the Advocacy Leaders Program requires full participation in all related programming, which includes eight virtual seminars in the coming fall/winter and the 2027 Summit from February 21-23 in Washington, DC. Yes
