ESCAPE to Thrive 2019 Alum

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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 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.*

Provide a list of other cancer-related conferences, trainings, events you attended in the past two years.*
What have you implemented in your advocacy that was a direct take away from information you received at a past ESCAPE to Thrive leadership conference(s)?*
Briefly explain the impact ESCAPE to Thrive had on your professional and/or personal life and your ability to be more effective?*
How do you envision this ESCAPE to Thrive leadership conference being right for you?*
What do you hope to achieve or gain by returning to ESCAPE to Thrive? What can you contribute?*
What year(s) did you attend ESCAPE to Thrive?*
  • ESCAPE Alum 2011
  • ESCAPE Alum 2012
  • ESCAPE Alum 2013
  • ESCAPE Alum 2014
  • ESCAPE Alum 2015
  • ESCAPE Alum 2016
  • ESCAPE Alum 2018

There are 4 ways for alums to return to ESCAPE to Thrive:

 

1. Complete this application. We will notify you of your application status if approved. 

 

2. Recruit two qualified first time advocates (from a different organization) 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 are confirmed with payment of your $549 all-inclusive fee and an approved* application.

 

3. Recruit a new ESCAPE to Thrive sponsor for $5,000+ and YOU are confirmed to attend (double occupancy) with an approved* application. NO all-inclusive fee for you! (Contact sherri@escape4advocates.org if you want information on sponsorships.)

 

4. Opt to confirm your space with an approved* application by paying in full to cover your stay at Miraval ($2,024 double occupancy or $2,540 single occupancy.) Reduced conference fee of $200 will also apply.

Which option are you planning to do?*

On what committee(s) would you like to serve?*
  • Alumni
  • Participant
  • Sponsorship
  • Program
  • None
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
  • Donation to BAG IT
  • Volunteer with BAG IT
  • Volunteer with ESCAPE to Thrive
  • Other
Additional Comments

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