Nominate a Survivor
If you've got a loved one currently in treatment for breast cancer, or soon to be, please fill out this form so we can surprise them with a Care Package.

If your nominated recipient does not qualify to receive a Care Package, (already received one, no longer in treatment, or out of the USA) we can send an inspirational card with any message you'd like us to include on your behalf.

Below you will find an area where we seek birth months. Since we already have the Survivor's birthday mid-form, we only need birth months for the immediate family members, such as spouse, children, even a parent or grandparent. The immediate loved ones that inspire the Survivor to keep on keeping on.

There is a $6 shipping charge for our care packages. Please make sure your payment follows form submittance. Package will not be processed without it.
Upon submitting form, you will be routed back to our donate page where you can select amount to pay and which form of payment you prefer.

*Please note....We are very backed up with requests and it may be a bit of time before your package heads out. To keep up with the status of your package, please go to our Facebook group: https://www.facebook.com/groups/fightclubsurvivor/
We will also email you tracking info.
  • 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.
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    It is important we receive this information so we can create their personal gift accordingly. Thanks!
  • 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
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  • Ex.: Facebook? Twitter? What Medical Facility? What Other?
  • We personalize each necklace for the recipient. Please make sure you have all immediate family members accounted for. *Aka: spouse, child 1, child 2, etc. Thanks so much!
  • We personalize each necklace for the recipient. Please make sure you have all immediate family members accounted for. *Aka: spouse, child 1, child 2, etc. Thanks so much!
  • We personalize each necklace for the recipient. Please make sure you have all immediate family members accounted for. *Aka: spouse, child 1, child 2, etc. Thanks so much!
  • We personalize each necklace for the recipient. Please make sure you have all immediate family members accounted for. *Aka: spouse, child 1, child 2, etc. Thanks so much!
  • We personalize each necklace for the recipient. Please make sure you have all immediate family members accounted for. *Aka: spouse, child 1, child 2, etc. Thanks so much!
  • We personalize each necklace for the recipient. Please make sure you have all immediate family members accounted for. *Aka: spouse, child 1, child 2, etc. Thanks so much!
  • We personalize each necklace for the recipient. Please make sure you have all immediate family members accounted for. *Aka: spouse, child 1, child 2, etc. Thanks so much!
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