Become a Living Beauty Registration

We call our participants "Living Beauties" because we feel this best represents who they are inside and out. Women over the age of 18 who have been diagnosed with any form of cancer - whether currently living with cancer or cancer survivors - are eligible to become Living Beauties. Once you're in our database, you will receive our emailed newsletters with invitations to our programs. All of our events are free to the women we serve. If you would like to become a Living Beauty and you meet these eligibility requirements, please register here.

First Name: Last Name: Email: Phone: Address: City: State: Zip: - Birth Date(MM/DD/YYYY): / / Approximate Annual Household Income How many people are in your household? Has your cancer impacted your household income? Has your cancer experience impacted your household expenses? (Optional) Please feel free to elaborate on the financial impact of your cancer experience. How would you self-identify your ethnicity? (This question is solely for our own demographic program purposes)

Asian/ Pacific Islander

Black

Latina

Native American

White

Mixed Ethnicity

Other

I decline to answer

What is your primary hospital? Type of Cancer(s) Date of your most recent diagnosis?

Year of your original diagnosis? (if different from your most recent diagnosis) Where are you on your cancer journey? Please list the programs/organizations that provide you support regarding your cancer diagnosis as well as the type of support they provide As of today, what are your greatest physical and emotional needs? How did you hear about us? (If a specific person referred you to the organization, please list their name) I voluntarily participate with full knowledge that there is risk of personal injury (including death), property damage and/or other loss. On behalf of myself, my heirs, personal representatives and executors, I hereby release, discharge, indemnify and hold harmless The Foundation for Living Beauty, its subsidiaries and affiliates, and their respective officers, directors, employees, volunteers and agents from and against any and all losses, liabilities, damages, actions, suites, demand or claims, of any nature or cause (each, a "Claim"), including costs and attorney's fees incurred by The Foundation for Living Beauty in connection with such Claim, arising from damages or injuries which may be sustained or caused by me, directly or indirectly, in connection with my participation with The Foundation for Living Beauty, whether or not caused by The Foundation for Living Beauty or it's officers, directors, employees, or agents or otherwise. By typing my name in this form, I agree that The Foundation for Living Beauty is in no way responsible for the safekeeping of any personal belongings while I attend Living Beauty events. My full legal name here acts as my signature and acknowledgement of liability. Photo Release

I grant The Foundation for Living Beauty the right and permission in respect of photographic portraits, pictures or videos that it has taken, to copyright the same, in its own name or otherwise; to use, re-use, publish, and re-publish the same in whole or in part, individually or in any and all media now or hereafter known, and for any purpose whatsoever, for illustration, promotion, art, editorial, advertising and trade, or any other purpose whatsoever without restriction as to alteration.

For privacy reasons, I prefer not to be photographed or my picture used in any social media posts. I take responsibility to alert the staff and/or event photographer of my request. I will be mindful to keep myself out of group pictures.

Solicitation Policy

Here at The Foundation for Living Beauty we are mindful of the financial hardships that cancer may cause. All of our programs are free of charge, and we only promote programs or resources outside of the organization that are free as well. As a registered Living Beauty and by clicking this box, you are agreeing to our no-solicitation policy. This policy states that you will not solicit other Living Beauties in regards to promoting your own business or programs at our events unless given permission by The Foundation for Living Beauty Staff.

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