Full Name

Email Address

Phone Number

Location (City, Province/State)

Gender

Birthday (day/month/year)

Are you currently in active treatment?

What expedition/retreat are you interested in?

Please summarize your cancer journey so far, including your diagnosis and current treatment status (i.e. in treatment, finished treatment, hormone therapy, etc.)

What do you hope to gain from this experience? What would you like to take away?

Will you need financial assistance to help pay for your trip fees or travel costs?
(Note: Financial assistance not available for Weekend Hangouts)

If so, how much money could you raise yourself?

Is there is a supporter that you'd like to bring with you (ie. spouse, best friend, sibling)? Please provide their name, email address and relationship to you, and we will contact them directly.

Have you ever attended an adventure trip or retreat with young adult cancer survivors before?

If so, which trips or events have you attended (list type of activity and organization)?

Do you have any allergies or special diets?

Do you have any specific questions for us?

Instructions

The questions in this form are to help us get to know you a little. Thanks for taking the time to fill it out and we will get back to you within 3-4 days with the detailed Expedition information form and the next steps to get you signed up!