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Holiday application

Details of the person making the enquiry:

Details of the person that has received a cancer diagnosis:

What is the above persons diagnosis & prognosis? Please provide as much detail here as possible:

Name of leading consultant and hospital:

Have you received a holiday from Jill's Fundraising Journey or any other charity before?

Yes

No

I agree to Jill's Fundraising Journey Terms & Conditions & Privacy Policy

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Thank you for your enquiry, we endeavour to get back to you within 5 working days. In busy periods this may take a little longer. If your enquiry is urgent please drop us an email at jfjapplications@gmail.com

Registered Charity Number 1160327

© 2017 Jill's Fundraising Journey