Base 2 Summit Registration

Base2Summit Program Application

  • Welcome to the Base2Summit registration! Your application is the basics we need to get started on placing you on a B2S week.

    If you do not complete this application in one sitting, select the “Save and continue later” option at the bottom of the form and a link for will populate. Please note, this link is only valid for 30 days. You must enter your email to have the link sent to you, we cannot access the link for you. Once sent, If you do not see the emailed link, check your spam folder.

    If you get stuck at any point, feel free to email for assistance

    Once you’ve completed the registration, the “Submit” button at the bottom of the application will light up. Please note ALL *stared* sections must be filled out before “submit” is possible.

    If, after starting this application, you find that you do not have the time to complete it, click the “Save and Continue Later” link at the bottom of this page. This will give you a link you can use to access your partially completed form in the next 30 days. You can also have this link sent to your email address.

  • General Information:

  • MM slash DD slash YYYY
  • Emergency Person:

  • Unisex sizes
  • Let’s get to know you a bit:

  • Healthcare Providers:

  • Primary Care:

  • Cancer Center:

  • Oncologist:

  • MM slash DD slash YYYY
  • Drop files here or
    Max. file size: 24 MB.
    • Health History Information:

    • Chemo, Radiation, Surgery, with most recent dates included
    • Medications

    • Create a list below or upload a typed list. If you’re not on medications, please type NONE or if you uploaded a list type UPLOADED.
    • Drop files here or
      Max. file size: 24 MB.
      • Authorizations:

      • Link to Base2Summit policy on tobacco, alcohol and cannabis
      • Link to participant release agreement
      • Drop files here or
        Max. file size: 24 MB.
        • This field is for validation purposes and should be left unchanged.