Are you a breast cancer survivor. We would like to hear from you!
Please complete the registration form below. Fields marked with a "•"are compulsory:
Your name and Surname: •
Your Age: •
Ethnical group: Black White Indian Other
Home Town: •
Contact Number: •
Email Address: •
When were you diagnosed? •
Do you ride a motorbike? Yes No
Comments:
Journey of Hope is a non-profit, registered Section 21 Organisation run by volunteer breast cancer survivors. Registration Number: 2008/020129/08 © 2009 Journey of Hope | Home | History | The Journey | Cause | Team | Sponsors | Fundraising | Gallery | News | Events || Contact