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Who Is CCC
Meet The Community
About Heart-to-Heart Day
Event Schedule
Photos
Videos
Contact Us
Helpful Resources
Facebook
Donate
Register Today
2026 Heart-to-Heart Day
Event Registration
Primary Attendee Name
*
Email Address
*
Phone
Age
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 and over
Relationship with CCC
ICD recipient
Pacemaker recipient
Sibling
Parent
Grandparent
Other family
Friend
I'm volunteering for CCC day
Lunch
No preference
Vegetarian
Gluten-free
Number of additional attendees. We will ask for their information next.
*
I will attend on my own
1
2
3
4
5
6
Does anyone attending have any food allergies or intolerances?
Other things we should know?
Additional Attendee #1
Name
Age
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 and over
Lunch
No preference
Vegetarian
Gluten-free
Relationship with CCC
ICD recipient
Pacemaker recipient
Sibling
Parent
Grandparent
Other family
Friend
I'm volunteering for CCC day
Additional Attendee #2
Name
Age
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 and over
Lunch
No preference
Vegetarian
Gluten-free
Relationship with CCC
ICD recipient
Pacemaker recipient
Sibling
Parent
Grandparent
Other family
Friend
I'm volunteering for CCC day
Additional Attendee #3
Name
Age
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 and over
Lunch
No preference
Vegetarian
Gluten-free
Relationship with CCC
ICD recipient
Pacemaker recipient
Sibling
Parent
Grandparent
Other family
Friend
I'm volunteering for CCC day
Additional Attendee #4
Name
Age
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 and over
Lunch
No preference
Vegetarian
Gluten-free
Relationship with CCC
ICD recipient
Pacemaker recipient
Sibling
Parent
Grandparent
Other family
Friend
I'm volunteering for CCC day
Additional Attendee #5
Name
Age
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 and over
Lunch
No preference
Vegetarian
Gluten-free
Relationship with CCC
ICD recipient
Pacemaker recipient
Sibling
Parent
Grandparent
Other family
Friend
I'm volunteering for CCC day
Additional Attendee #6
Name
Age
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 and over
Lunch
No preference
Vegetarian
Gluten-free
Relationship with CCC
ICD recipient
Pacemaker recipient
Sibling
Parent
Grandparent
Other family
Friend
I'm volunteering for CCC day
Submit
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