Roadtrip to recovery 2.0 application

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Do you identify as a Black woman who has lived with breast cancer? *

Yes

No

Do you understand that you are responsible for your travel expenses to all RTR 2.0 destinations? *

Fight Through Flights and our partners will provide wellness experiences and meals ( as well as accomodations in Idaho and Illinois). Travel expenses to all destinations are the participant's responsibility. We encourage local and regional participation but you are welcome to apply to any location you can get to!

Yes, I can cover my own expenses to travel to the program destination

No, I cannot cover my own travel expenses to the program destination