2019 APPLICANTS "OPEN"


PLEASE DO NOT APPLY UNTIL YOU COMPLETE THE FOLLOWING STEPS:
 
  • Read Tina’s Place FAQ page on our website to understand all the requirements prior to filling out an application. Click on FAQ above
  • ALL applicants must "like" our Facebook page or follow us on Twitter.

    Facebook: https://www.facebook.com/tinasplacemi
    Twitter: https://twitter.com/tinasplacemi
     
  • Fill out the application on our website in its entirety.
    If you fail to do so, your application will not be processed.
Requirements for Tina's Place attendance:
Patient (adult) must have a current diagnosis and be under treatment for Stage III or Stage IV (child) stage II and up) melanoma. If an application is approved, the patient will be required to supply medical verification and clearance from their oncology healthcare team. Previous guests or cancellations may not reapply.

Applications are NOT first to come, first served. Once your application is received, the board will review it closely and inform you only if your family is selected to attend. Due to the large volume of applications, we cannot respond to every application.

Tina's Place has a required $75 deposit for any warrior accepted. This must be paid within 10-days of acceptance or your invitation will be rescinded. It will be totally refunded sometime prior to your departure day. If you cancel for any reason (except for with a doctors fax explaining that you are unable to attend) the deposit will become a donation to Tina's Place. Please do not apply unless you fully agree with this deposit requirement.

Note: The application which follows asks if this would be your family's only get away for the year. Please apply, whether your answer is yes or no. While we do not restrict our guests to only those who have no other vacation options we're especially eager to assist those families who have no other opportunity to escape the daily grind of melanoma treatment.

The information below pertains solely to the patient, not to the person filling out the application. 

*Tina's Place reserves the right to fill dates and offer/rescind an invitation with or without explanation, cause, or reason.

* Indicates a Required Field - ALL Fields Required

Melanoma Warriors Information
* Required Questions:
  I have read the FAQ page
  I have liked/followed Tina's Pace on Facebook or Twitter

Would this be your family’s only chance of a getaway/vacation?
   Yes    No

I understand that if selected for a retreat, my family is responsible for any cost associated with traveling to, from and during the retreat location
   Yes    No

The information below pertains solely to the patient, not to the person filling out the application.
* First Name:
 Middle Name:
* Last Name:
* Email:
* Home Phone:
(Numbers only please, no spaces or special characters)
* Cell Phone:
(Numbers only please, no spaces or special characters)
* Address:
Address 2:
* City:
* State/Province:
* Postal Code/Zip Code:
* Birthday:
* Age:
* Gender:
* Your Facebook Personal Profile URL:
(ex: https://www.facebook.com/tinasplacemi)
* T-Shirt Size:
Dates and Guest Information
Please check 3 dates that work for you:
June 03 - June 09
June 10 - June 16
June 17 - June23
July 01 - July 07
July 08 - July 14
July 15 - July 21
July 22 - July 28
July 29 - August 04
August 05 - August 11
August 12 - August 18
August 19 - August 25
August 26 - September 01
September 02 - September 08
September 09 - September 15
September 16 - September 22
September 23 - September 29
All of these dates work for me!
Number of immediate family members (up to four) you're hoping to bring with you, including spouse/partner/kids 18 and under:
Names, Ages and Relationship of those attending:
Cancer Diagnosis Information
* Initial Diagnosis:
* Stage:
* Oncologist Name:
* Oncologist Phone:
Medical Treatment and Limitations
Explain what treatment you are currently on:
Can you climb stairs to get down to the cabin:
Do you have any physical limitation:
Please explain why you should be selected to be our guest. Include any information you deem appropriate, such as financial hardship, and whether this would be your family's only chance for a getaway. Provide any other information that may help with our Application Committee review process:

(maximum 1000 characters)
How did you hear about Tina's Place?
Form Validation

Once we receive your application, we will review it closely. Due to the large number of applications we receive, you will only be contacted if you are selected.

If you have any questions, please contact us at tinasplacemi@yahoo.com. We look forward to reviewing your application!


"Take care of your body. It's the only place you have to live."

- Jim Rohn

Donate Now and join us in our efforts by making a donation today.

Tina's Place is dedicated to providing melanoma patients a free haven. Donate now to help support the cause.