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Welcome to the "Peace of Mind at Home" free colon cancer screening and awareness event registration form. This event is organized by Trials of Color to provide screening and Education about Colon Cancer. 

This free colon cancer screening and awareness event will take place in Petersburg Public Library on November 6, 2026 11AM EST ( 201 W, Washington Street, Petersburg VA, 23803). 


Please complete the form with your accurate information. Your responses will help us prepare for the event and support follow-up communication if needed.


Call: Trials of Color on (804) 360-9214 for more information.
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Name
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1. Which age group best describes you?
40-45
46-50
51-55
56-60
61-65
66 and older
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2. What is your location?
Please enter the area, city, neighborhood, or other location information that best describes where you live.
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3. Have you ever had colon cancer screening before?
Yes
No
Not sure
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4. How did you hear about this event?
Flyer or poster
Community organization
Friend or family member
Social media
Church or faith group
Health care provider
Other
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5. If you selected Other, please specify how you heard about the event.
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6. Will you attend the event on November 6 at 11:00 AM EST?
Yes, I plan to attend
Maybe, I need more information
No, I cannot attend
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7. Would you like to be added to the Trials of Color email list?
If yes, please enter your email address. If no, you may leave this blank.
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