November 20, 2013

Send a Basket

bosom-buddy-basket-picture-for-website-small-300-100bosom-buddy-basket-picture-for-website-small-300-100bosom-buddy-basket-picture-for-website-small-300-100bosom-buddy-basket-picture-for-website-small-300-100Our Bosom Buddy Baskets are personally created by a small group of caring women and are specifically made for any woman diagnosed with breast cancer.

The basket includes our exclusive Bosom Buddy Booklet which contains tools & tips from breast cancer survivors, along with practical advice for the journey a breast cancer patient faces and many items to comfort and educate them to let them know they are not alone. We PROMISE she will love it!

Send Your Basket Here:

FIRST NAME of Person who Needs a BASKET SENT TO:

LAST NAME of Person who Needs a BASKET SENT TO:

Basket Recipient Street Address:

Basket Recipient City: State: Zip Code:

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

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

Diagnosis
Recent Diagnosis Awaiting Treatment PlanAwaiting MastectomyAwaiting LumpectomyRecent MastectomyRecent LumpectomyUndergoing ChemoUndergoing RadiationOther

Hospital Name if having surgery (We may already be delivering a basket to her in an area hospital):

Is this a Residential Address?: YesNo

Your FIRST NAME:

Your LAST NAME:

Your Street Address:

Your City: Your State: Your Zip Code:

Your Email:

Your Phone:

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

CARD MESSAGE: The IIIB's Foundation relies on donations to continue our mission of providing comfort to breast cancer patients. A donation is not required, but if you are making a donation, please provide us with a personal message we will handwrite and send with basket:

Donation Amount (Please feel free to email: theiiibs@keepthecandleglowing.org if you are unable to donate.)
$150$300$500$75$50$25OtherNone

NOTE TO THE IIIB's FOUNDATION:

"I prefer to keep my donation anonymous.""Make my donation in acknowledgement of the recipient.""I do not wish to receive future email coorespondence.""My contribution will be matched by my employer."

Please use "SEND REQUEST" BUTTON

You will then have an opportunity to MAKE A DONATION.

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

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