Card Request

Welcome recipients, families, friends and professional contacts! Cards are sent free of charge across the United States. These cards are handmade and include a personal message. Please fill out the information below. We hope to have cards mailed out within 4-6 weeks of the referral.

Important information: Personal information will be kept confidential. Please keep in touch with us and let us know if you would like an additional card. Also, we would love to see photos of our recipients with their card. Email to aleeza@cardcareconnection.com.

Request Form

• Recipient Information
• Name: *Required
• Gender: Male Female *Required
• Age Range: Child Teen Adult *Required
• Mailing Address: *Required
• City/State/Zip:    
• Cancer Type: *Required
• Helpful Information:
  (facility name if applicable; any favorite hobbies, interests, themes, or colors that can be represented on card; birth date if this is a birthday card; this card is for a child; etc.)
• Referral Source: Signing up for myself Signing up for a loved one Professional referral
• How did you hear about us? *Required

• Your Information
• Name: (optional)
• Email: (optional) Invalid Email
• Referring Organization: (optional)
• Captcha:
• Please enter the value seen in the image above, if you have problems viewing image please refresh the page and a new image will be generated.
•   *Required

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