ESCAPE to Thrive 2019

If you are an ESCAPE to Thrive alum there is a separate application for you.  

Click here! 

ESCAPE to Thrive

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*
Organization Name
Position/Title in Organization
Organization Website
Age*

Have you had or are you living with cancer?*
  • Yes
  • No
If yes, cancer type
Advocacy Involvement (Check all that apply.)*
  • Cancer Trial/Research Reviews
  • Exercise Group
  • Legislative/Public Policy
  • Navigation
  • Patient Education
  • Retreats
  • Support Groups
  • Survivorship
  • Young Survivors
  • Other (explain below in additional comments section)

Please fully answer each of the questions below. Target each response to approximately 500 words. 

For each advocacy involvement indicated above, describe your advocacy role, your dates and duration of involvement, the nature of your role, who/how many people you served and their demographic.*

How do you envision the ESCAPE to Thrive leadership conference being right for you?*
What do you hope to gain from the ESCAPE to Thrive leadership conference? What do you hope to contribute?*
Provide a list of other cancer-related conferences, trainings, events you attended in the past two years.*
What attracts you to the ESCAPE to Thrive leadership conference?*
If accepted, in what ways are you willing to share your ESCAPE to Thrive experience and/or support BAG IT? (Check all that apply.)*
  • Social Media
  • Blogging
  • Testimonial
  • Share ESCAPE announcement flyers with your database
  • Contact new potential sponsors in behalf of ESCAPE
  • List BAG IT (bagit4u.org) as a resource on your website
  • Volunteer with BAG IT
  • Volunteer with ESCAPE to Thrive
  • Other (explain below in additional comments section)
How did you learn about ESCAPE to Thrive? (Check all that apply.)*
  • Alumnus
  • Conference
  • Email Blast
  • Facebook
  • Another Advocate
  • Search Engine
  • Twitter
  • Other (explain below in additional comments section)
If referred by an alum please enter name.
Anything else you want to tell us?

To receive a discount on your registration fee:
 
Recruit two qualified new advocates (from different organizations) to apply to ESCAPE to Thrive. Once they have been accepted and have paid their $100 non-refundable deposit toward their $549 all-inclusive fee, YOU will receive a $50 discount on your all-inclusive fee.
Please include name, email & organization of each person.

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