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Thank you for your interest in the Tigerlily Foundation ANGEL Advocacy Program. Those who have experience with breast cancer can make a significant impact and BE THE CHANGE!

We are currently accepting applications from individuals who are interested in advocating for health equity in breast cancer by eradicating disparities of age, stage and color, especially for young Black women who face the greatest breast cancer inequities.

Contact Information

Email*

First name*

Last name*

Phone number*

Street address*

City*

State*

Postal code*

Country/Region

Demographic Information

Birth Year

Experience with Breast Cancer

Which Best Describes Your Breast Cancer Experience?*

Breast Cancer Patient/Survivor (a person with stage I-III breast cancer, both during and after treatment)

Living with Metastatic Breast Cancer

Family Member or Friend

Healthcare Professional

Student

Other

What type(s) of advocacy are you interested in?*

Public Speaking

Social Media Content and Sharing

In-Person Community Events

Document and Protocol Reviews & Editing

Research and Clinical Trials

Hosting or facilitating a workshop/training

Policy and Legislation Advocacy

Patient Navigation and Advocacy

Please note any other types of advocacy you are interested in that were not listed above.

Do you serve as an Advocate any other Breast Cancer Organization and or other Organization?

Consent

I wish to participate in the ANGEL Advocacy Program and my participation is wholly voluntary.

I release and fully discharge the Tigerlily Foundation, and its employees, officers, and agents, from all liability in connection with my participation in the ANGEL Advocacy Program for, or on account of, any injury to or illness of my person or death or for, or on account of, any loss of damage to any personal property or effects owned by me.

I authorize the Tigerlily Foundation to communicate with me via email for program updates and reminders.

I authorize the Tigerlily Foundation to use my name, photograph, brief biographical and contact information, and any portion of my testimonial in written, photographic, or digital format for publicity, recruitment, and educational purposes. I grant the Tigerlily Foundation sole editorial discretion over the finished product, including written copy, wherein my likeness, name, identity, or my testimonial appears. I hold harmless and release Tigerlily Foundation from all claims, demands and causes of action that I, my heirs, or representatives have or may have by reason of this authorization. I represent that I have read and understand the foregoing statement and am competent to execute this release.

I pledge to advance health equity and remove barriers to care in historically underrepresented communities. I commit to using my voice to educate, advocate, empower and my community.

Inclusion Pledge Commitment

Preferred t-shirt size. Please note this is for a fitted women's t-shirt. You may wish to go up one size from your usual size.