Please sign up here to register to use our services and attend our events.  You are eligible to receive our services if you were diagnosed with cancer or have cancer between the ages of 20-45 years old.  

Name *
Name
Date of Birth *
Date of Birth
This helps us send information that is specific to you
Gender I identify with:
Ethnicity
Ministry of Health Ethnicity Groups
Other, please describe
Address *
Address
Preferred Phone for Contact *
Preferred Phone for Contact
Photo Release

Thank you for your interest in our services!

We collect personal information from you in order to safely provide support and services for you and the rest of our community.  This information is confidential and only our staff have access to it.  We never pass on your information to any third party, unless required by law.

Providing some information is optional. If you choose not to enter a completed membership form however, we'll be unable to accept you for our retreat programme.

You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong. If you’d like to ask for a copy of your information, or to have it corrected, please contact us at support@wholelottalife.org, or 0211199127.