Cancer Survivors

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First Name*

Last Name*

Email*

T-Shirt Size (unisex sizing)*

Cancer Type or Color of Cancer Ribbon

This is my*

I am booked on the 2020 Buckeye Cruise for Cancer*

Would you like to participate in opening night ceremonies?*

Would you like to participate in the Survivor/Athlete Breakfast on the ship?*

Do you authorize the Buckeye Cruise/OSUCCC - James to use your name, photo, and/or story when promoting the Buckeye Cruise for Cancer?*

Tell us why you support the Buckeye Cruise for Cancer (limit 250 characters)

Optional: Submit Photo Here

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I voluntarily give my permission to The Ohio State University and Buckeye Cruise for Cancer for my image and/or voice to be recorded, published and/or distributed for news, educational, marketing or publicity purposes. I understand that once this protected information is printed, recorded and/or electronically posted, Ohio State nor the Buckeye Cruise for Cancer retains no further control over its use.*

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Cancer Survivors

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