Application for Financial Assistance from NJC Memorial Fund

If you or a loved one on is battling with Lung Cancer and would like to be considered for assistance from the NJC Memorial Fund please print the application form and mail to

NJC Memorial Fund
4231 West Yorkshire Drive
Glendale, AZ, 85308-7556

NJCMEMORIALFUND@COX.NET

By signing this form you are authorizing NJC to confirm the patients Lung Cancer, by contacting their doctor(s).  NJC follows HIPPA regulations in maintaining client privacy.  The NJC board meets monthly to review applications and make a determination.  You will be contacted as soon as a decision has been made.