Fee Waiver

2023 Wellness Summit: Fee Waiver Application

YSC’s Fee Waiver program seeks to alleviate the financial burden of attending the YSC Wellness Summit and facilitates equitable access to quality education and a supportive community for all who need it.

Fee Waivers provide a waiver for the entire registration price of $150.

Fee waivers are available to attendees in the Restore and Tour de Pink (TDP) Tracks. TDP riders must still meet their fundraising minimums.

Note: Each applicant must use a personal, unique email address (not a shared/family email address) for this application. If approved, you will use the same unique email address to register for the 2023 YSC Wellness Summit.

Eligibility Requirements

Priority is given to young breast cancer survivors and young adults living with metastatic breast cancer, as well as their co-survivors.
You must be in good standing with YSC and our past conferences/events. YSC reserves the right to decline financial assistance, if an individual provides misinformation in the application process or shows misconduct at any time.

Contact Information

First Name

Last Name

Organization (if applicable)

Each applicant must use a unique email address.

Address

City

State/Province

Please use two letter state code, e.g., PA, LA, HI if applicable.

Zip/Postal Code

Country

Phone

Phone Type

Personal Information

Birthdate

MM/DD/YYYY

Gender

Ethnicity

Select all that apply:

I am a person who has been diagnosed with breast cancerI am a co-survivor* (caregiver/family/friend) of someone diagnosed with breast cancerI am a healthcare providerNone of the above

What date were you first diagnosed with breast cancer?

MM/DD/YYYY

At what age were you diagnosed with breast cancer?

Have you been diagnosed with metastatic breast cancer?

YesNo

What year were you first diagnosed with metastatic breast cancer?

What is your relationship to the diagnosed person?

Please list the name of the conference participant (survivor) you are accompanying:

What type of health care provider are you?

Please briefly explain your interest in attending this event (100 words or fewer).

I need financial assistance to cover the conference registration fee of $125 (early bird rate) or $150 (general registration).

YesNo

Please briefly describe your financial need as it relates to attending the conference (100 words or fewer).

Contact Information