Young Adult and Teen Burn Survivor afternoon at the PLUNGE

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Young Adult and Teen Burn Survivor afternoon at the PLUNGE

November 18, 2023 @ 1:30 pm - 4:00 pm

Join other young adult and teen burn survivors for a fun afternoon of community building at the PLUNGE San Diego!

Questions? Contact Jeaninne at [email protected]

Name*
First Last
As it appears on your drivers license or ID card
Gender*
- Male
- Female
- Non-binary
- Other
- Prefer Not to Disclose
Date of Birth*
MM slash DD slash YYYY
Phone*
Email*
Hidden
Address*
Street Address Address Line 2 City ZIP / Postal Code
Do you have any food allergies or preferences?
Image, Video, and Information Release
I DO AUTHORIZE THE BURN INSTITUTE TO USE PHOTOGRAPHS, VIDEOTAPES AND/OR INTERVIEWS OF ME TO FURTHER THEIR EFFORTS TO PROMOTE PUBLIC AWARENESS AND SUPPORT
WE REQUEST YOUR PERMISSION TO FILM, PHOTOGRAPH OR INTERVIEW YOU TO HELP OUR EFFORTS IN INCREASING PUBLIC AWARENESS AND SUPPORT OF OUR PROGRAMS BY APPEARING IN PHOTOGRAPHS, VIDEO OR OTHER PUBLICITY THAT THE RETREAT MAY PRODUCE.

Details

Date:: November 18, 2023
Time:: 1:30 pm - 4:00 pm
Event Category:: Burn Survivor Events