Sunday, April 18th

3:00-4:00

Have fun playing virtual bingo for your chance to win Amazon gift cards for your shopping pleasure. Please be sure to shop through AmazonSmile and choose Respite Retreats or Bryanna’s Love as your charity of choice.

You will receive an email with instructions for accessing your bingo cards and Zoom links on or around April 14th. Please be sure to check your email (and spam) to confirm receipt prior to the event. If you do not receive it, please contact Lisa at lhermodsson@respiteretreats.org.

Bingo is limited to 98 participants and will be accepted on a first-come, first-serve basis. Good luck & have fun!

For more information about our partnering sponsor, Bryanna’s Love, please go to www.bryannaslove.org.

PLEASE REGISTER BY COMPLETING THE BELOW QUESTIONNAIRE.

Please know that the information we are requesting is for demographic purposes only. It plays a very important part in securing grants and funding sources, making it possible for us to provide this and other programs designed to Refuel your Spirit at no cost to you. Please know that both Respite Retreats & Bryanna’s Love will receive this information.

FOR CANCER PATIENTS & THEIR FAMILIES

I understand that this Bingo Bonanza event is for those with cancer or within 6 months of active treatment and their families.

PATIENT'S NAME

First Name

Last Name

ADDRESS

CITY

STATE

ZIP CODE

PHONE NUMBER

DATE OF BIRTH

RACE

TYPE OF CANCER & STAGE

TREATING HOSPITAL

NAME & RELATIONSHIP OF PERSON COMPLETING THIS FORM

PLEASE LIST NAMES & AGES OF THOSE PLAYING BINGO WITH US

Siblings and caregivers welcome. :)

MESSAGE

I am interested in participating in future Virtual Retreats.

Yes, please contact me with more information about your Virtual Retreats.

No Thanks.

I am interested in a free photo shoot.

Yes, please contact me with more information about a photo shoot.

No Thanks.

I am interested in having stuffed animals sent to my children from Respite Retreats partner Bryanna's Love

Yes, please share my information with Bryanna's Love and have them contact me.

No Thanks.