True North Treks


True North Treks Participant Application
Your name and address
First Name *
Last Name *
Address 1 *
Address 2
City *
State/Province *
Zip
Country *
Additional contact and other information
Email *
Phone *
Phone Type *
Social media (e.g. Twitter, Facebook, Instagram) names or handles:
My Social Media
Contact Type Preference *	Email Phone Call Text Message Instant Message Other
Other Contact Type Preference
Timezone *	Eastern Central Mountain Pacific Other
Other Timezone Preference
Contact Day Preference *	Any Weekdays Weekends Other
Other contact days
Contact Time Preference	Any Early Morning (before 9a) Mid-Morning (9a-noon) Afternoon (noon-5p) Early Evening (5-7p) Other
Other Contact Day or Time Preference
Current age *
Birth Date *	// (mm/dd/yyyy)
Below we ask some questions about your gender identity, sexual orientation, and racial and ethnic background. We are asking because they reflect important aspects of one's identity and culture, and because we are constantly trying to make sure our programs are as inclusive and representative as possible.
Gender *
Preferred Personal Pronoun *
Sexual Identity
Race/Ethnicity *
Each trek participant receives a True North Treks t-shirt (standard unisex).
T-Shirt Size *	X-Small Small Medium Large X-Large
Where did you hear of True North Treks? *	Internet Search My cancer treatment center Someone who's been on a trek StupidCancer.org Support Group Other
Please tell us more about how you learned about True North Treks
Emergency Contact (EC) information
EC First Name *
EC Last Name *
EC Phone Number *
EC Email Address *

Timeout Warning

True North Treks Participant Application

Your name and address

Additional contact and other information

Emergency Contact (EC) information