Your Name (required)

Your Email (required)

Phone Number (required)

Location (City, Province/State)(required)

Gender (required)

Birthday (day/month/year, required)

Are you currently in active treatment?

What expedition/retreat are you interested in? (required)

In a couple sentences summarize your cancer journey so far. Please include your treatment status (recently diagnosed, in treatment, finished treatment, hormone therapy, etc.) (required)

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

Will you need financial help to cover your trip fees?(required, financial assistance not available for Weekend Hangouts)

If so, how much money could you raise yourself?

Do you have a close supporter that you would like to bring with you?

If so, please indicate their name, email address and relationship to you (ie. spouse, best friend, sibling, etc.)

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

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

Do you have any allergies or special diets?

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!