PLEASE FILL OUT COMPLETELY

***** No private information (ie: your mailing address or last name) is posted on the webpage we create or released to our members.
Your Name (required)

Phone Number (include area code)(required)

Your Email (required)

Are you currently a ShareaCard participant?
YesNo

If no, how did you hear about our program?

How would you like us to contact you?
PhoneEmail

We will need a photo to place on our website, which method will you be using to send us the photo?
MailEmail

We will contact you later to retrieve the photos.

Feature's Name (required)

If under 18, provide Parent's Name

Street Address (required)

Feature Phone Number (include area code)(required)

Feature Email (required)

How did you hear about ShareaCard?

Illness/Diagnosis (required)

Birthdate

Feature Bio (required)

Hobbies and Interests (required)

By submitting the information for the feature you have explained the program and the feature is aware and agrees to the following: to allow ShareaCard to post the information from their Bio, the picture provided and the address information. ShareaCard.org and CAC Friends.com does not pre-screen communications in advance and is not responsible for screening or monitoring materials (cards) sent by participants. By submitting this information you acknowledge you understand that ShareaCard has no liability or responsibility to Features for materials mailed from participants or content therein.

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