*In order to best support you, BCFM works with non-profit partners, and may confidentially provide your information to other non-profits or healthcare agencies and may request information about you from these agencies. BCFM will never sell your information or share it with solicitors.

I certify that this information is true to the best of my knowledge and I agree to the terms listed above as of the date indicated below. I understand that The Blood Cancer Foundation of Michigan is a non-profit, community organization. Provision of services is subject to approval by the BCFM Board of Directors and may be discontinued at any time with or without notice. BCFM will contact me upon receipt of my completed application.