I want to be a member... because I'm awesome

4/12/2018

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I want to become a member... because I'm all the colours of awesome.

Bravery Boxer membership sign up or in other words
"I want to be in the in crowd"

* Indicates required field

Name *

First

Last

Mobile *

Email *

Postal Address: *

My story - many of us have stories of why the Bravery Box resonates with us. The story might be that you want to connect to something bigger, this story may be that of your child undergoing treatment or you or your mother or your child may have a different non-cancer mountain shaped challenge. *

What type of Bravery Boxer are you? *

Childhood Oncology Family (please continue to fill in the bottom of this form) Community Bravery Boxer (thank you for joining, you are all the colours of wonderful- scroll down to the bottom and press submit) I'm a business and would like to support Bravery Box - also I rock (thank you - please scroll to the bottom and press submit)

Childhood Oncology Family - Parent's name *

Diagnosed child's name, age and diagnosis (including on, off treatment or our angel babies) *

Date of Diagnosis *

Treating Hospital (we currently support Lady Cilento Children's Hospital but families from all over can join this group) *

Name of Oncologist *

Siblings names and ages *

Diagnosed child's shirt size and postal address (if you'd like a This is What BRAVE looks like Shirt- we currently are only funded to provide shirts to Qld Children's Hospital. If you are at a different treatment hospital, welcome, we'll still send your child a little message in the mail)) *

Home address (please put your home address and mention to us if you are in short or long term hospital accomodation) *

Submit

0 Comments

I want to be a member... because I'm awesome

Bravery Boxer membership sign up or in other words ​"I want to be in the in crowd"

Leave a Reply.

Bravery Boxer membership sign up or in other words
"I want to be in the in crowd"