Thank you for your interest in joining us in 2025 for a Children's Brain Tumor Foundation (CBTF) Heads Up Conference. After hosting camps in Montana for over 15 years, we are ready to expand. The 2025 CBTF Heads Up Conferences will be in new locations and teen and adult campers will attend sessions together. Our goal is to build and grow CBTF communities throughout the US and keep families connected throughout the year. This form is for teen brain tumor survivors ages 13-19 and will help us determine next steps in the application process. This form must be completed by a parent/caregiver if the chid is under the age of 18.

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* 1. What is the first name of the participant?

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* 2. What is the last name of the participant?

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* 3. What is the participant's date of birth?

Date

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* 4. Who is completing this form?

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* 5. At what email address would you like to be contacted about your application?

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* 6. At what phone number would you like to be contacted about your application?

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* 7. How did you hear about us?

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* 8. Address 1 (street/mailing address)

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* 9. Address 2

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* 10. City

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* 11. State

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* 12. Zip

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* 13. Sleeping areas are assigned based on gender identity. The participant identifies as

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* 14. Participant preferred pronouns

T