Nominate a Survivor
This form must filled out followed by payment.

Please fill in the following information. If the Survivor does not qualify for a package, we will gladly send a card on your behalf at no cost.
*If you've already donated, a refund will be given.

To qualify for a package:
Survivor must be in active treatment or will be soon.
Survivor has not received a package from us within the past year.

There is a requested donation amount of only $11.11. This donation helps offset the cost of shipping & handling. Package cannot be processed without it.

Please feel free to join our Facebook group to watch for the package shipment announcements, inspirational posts, and chatter with fellow Survivors. Family & Friends are welcome as well as the Survivor!

Tracking information will be provided asap.

If your nominated Survivor does not qualify for a package and you would like a card mailed instead, please be sure to check mark "Yes" at the bottom of the form. No donation is requred.
  • This email address will receive USPS tracking notification about package delivery status. If you want this package to be a surprise, we advise you to enter YOUR email address, not the one receiving the package.

    We will only contact you if we have questions regarding this form.
    You will receive tracking notification from USPS regarding this package.
  • - -
    We will only contact you if we have questions regarding this form.
  • It is VERY important that we have the first & last name of the care package recipient since one of our gifts is personalized with their initials. Thank you!
  • We email birthday wishes at the beginning of each month.
  • We will not use this address for any other purpose.
  • / /
    We post monthly birthday greetings in our Facebook group.
  • / /
  • Types of Breast Cancer

    Based on where your cancer begins and how it spreads, your cancer will be characterized according to different types and stages. Although there are many types of breast cancer, below is a breakdown of some of the common types:

    *DCIS – Ductal Carcinoma In Situ – DCIS is the most common type of non-invasive breast cancer that starts in the milk ducts and has not yet spread into any normal tissue (Stage 0)

    *LCIS – Lobular Carcinoma In Situ – LCIS is an area in the milk-producing glands (lobules) of abnormal cell growth that indicates a person has a higher risk of invasive breast cancer in the future (Stage 0)

    *IDC – Invasive Ductal Carcinoma – IDC accounts for 80 percent of breast cancers and refers to cancer that started in the milk duct and invaded nearby breast tissue (Stages I-IV)

    *Recurrent and Metastatic Breast Cancer – Recurrent and metastatic refers to breast cancer that has returned after temporarily successful treatment or cancer that has spread beyond the breast and into other parts of the body
  • Ex.: Facebook? Twitter? What Medical Facility? What Other?
  • Image Verification
    Please enter the text from the image:
    [Refresh Image] [What's This?]