November 20, 2013

Send a Mastectomy Basket

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WHO IS A CANDIDATE?

PRE-OPERATION MASTECTOMY PATIENTS

Our Bosom Buddy Baskets are personally created by a small group of caring women. The Baskets are specifically made for Pre-Operation Mastectomy Patients awaiting breast cancer mastectomy surgery and are designed to be most useful during the first Five Days Post Operation with items used in the immediate recovery process following mastectomy surgery.

Our Bosom Buddy Baskets are Not designed or intended for patients that have already had Mastectomy surgery or other breast cancer treatments such as lumpectomies, chemo or radiation.

If you or someone you know are a candidate, request a Bosom Buddy Basket Below.

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HOW DO I SEND A BOSOM BUDDY BASKET?

$150 PROVIDES 1 BOSOM BUDDY BASKET

We are a very small non profit organization trying to keep up with high demand but want to ensure that every woman going through mastectomy surgery today will receive the comfort and support for which our Bosom Buddy Baskets are designed. We rely 100% on donations to deliver our comfort baskets to women who need them.

*Please consider making a Tax Deductible donation of $150 for the requested basket but any amount will be greatly appreciated.

*(Please feel free to email: theiiibs@keepthecandleglowing.org if you are unable to make a donation for the requested basket.)

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BOSOM BUDDY BASKET REQUEST FORM

Diagnosis - Our Bosom Buddy Basket is a surgery recovery basket created specifically for mastectomy surgery patients and not suited for other treatments such as lumpectomy, chemo or radiation. Please bear in mind that we are a non profit and we need your help to ensure that each of our Bosom Buddy Baskets are given to the women they are designed help and comfort in the right time of their journey. Thank you for your kind consideration of placing an order for only those patients Awaiting Mastectomy Surgery.

Date of Mastectomy:

Hospital Name Where Having Surgery (We may already be delivering a basket to her in an area hospital.):

Donation Amount:
$150- cost of 1 Bosom Buddy Basket$500$300$75$50$25-covers average delivery costOther

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FIRST NAME of Basket Recipient:

LAST NAME of Basket Recipient:

Country of Delivery: USOther

Basket Recipient Street Address 1:

Basket Recipient Street Address 2 (if applicable):

Basket Recipient Street Address 3 (if applicable):

Basket Recipient City: State: Zip Code:

Basket Recipient Phone: (Please enter your phone if you do not have theirs)

Phone Extension: (if applicable):

We cannot deliver to any hospital that we are not connected to as the basket gets lost in transit.
To confirm this is a Residential Address, Please check "1": 1

Basket Recipient Email: (Please enter your email if you do not have theirs)

SENDER's INFORMATION:

Your FIRST NAME:

Your LAST NAME:

Your Street Address 1:

Your Street Address 2 (if applicable):

Your City: Your State: Your Zip Code:

Your Email:

Your Phone:

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(Required) HOW DID YOU HEAR ABOUT US? Please let us know who referred you:

Individual Name:

Facebook Group Name (full facebook group name required):

Other Referral:

NOTE TO THE IIIB's FOUNDATION:

Please use "SEND REQUEST" BUTTON

You will then have an opportunity to MAKE A DONATION.

Some items in Basket will change from time to time from the pictured basket.

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