Application Information 

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 25% of survey complete.

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* 1. First and Last Name

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* 2. Email Address

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* 3. Mailing Address (please include your country of residence)

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* 4. Age

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* 5. Cell Phone:

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* 6. Have you participated in Brushes with Cancer?

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* 7. How did you hear about Brushes with Cancer?

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* 8. Are there additional Brushes with Cancer Programs you are interested in participating in?

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* 9. Have you or a loved one been touched by cancer?

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* 10. How do you identify?

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* 11. Brushes with Cancer requires a four month time commitment for both the subject and artist. During this time the person touched by cancer will share their journey with the artist who will be charged with creating a unique piece of artwork that is reflective of that journey. We require that participants either meet regularly in person, on the phone or via skype in order to build a meaningful relationship. Please acknowledge that you are willing to commit the time and effort necessary to participate in this program. 

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