Contact Info

First Name

Last Name

Country United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Islands Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Island Costa Rica Cote Divoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Egypt El Salvador Equador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Macdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia (Rep. of Fmr Yugoslav) Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Metropolitan France Mexico Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda S. Georgia and S. Sandwich Islands Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St Helena St Kitts and Nevis St Lucia St Pierre and Miquelon St Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands - British Virgin Islands - US Wallis and Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe

Address 1

Address 2

Postal Code

City

State/Province Alabama Alaska American Samoa Arizona Arkansas Armed Forces Europe Armed Forces Pacific Armed Forces the Americas California Colorado Connecticut Delaware District of Columbia Fed. States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Is. Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Phone Number

Email Address

Yes, I would like to receive email communications.Yes, I would like to receive email communications.

GenderFemaleMale

Date of Birth

Are you a Cancer Survivor?Breast CancerOther Cancer

Retreat Information

Retreat Role for Week Volunteer Leader

Please select the retreat you have been invited to attend. You will need to submit this form for EACH retreat you are attending if more than one.

2026 Volunstar Retreat WeeksMarch 7 - March 14 - Myrtle Beach, SCApril 11 - April 18 - Carolina Beach, NCApril 25 - May 2 - Oak Island, NCApril 25 - May 2- Scottsdale, AZMay 2 - May 9 - Topsail, NCMay 2 - May 9 - St. John, USVI (couples only)May 9 - May 16 - Hatteras, NCMay 10 - May 17 - New Smyrna Beach (couples only)May 30 - June 6 - Ocean City, MDMay 30 - June 6 - Marco Island, FLJune 6 - 13 - Key West, FL June 6 - June 13 - Sedona, AZJune 20 - June 27 - Blue Ridge, GAAugust 15 - August 22 - Emerald Isle, NCAugust 15 - August 22 - Orange Beach, ALSeptember 12 - September 19 - Lake Tahoe, CASeptember 12 - September 19 - Deep Creek, MDSeptember 12 - September 19 - Mystic, CTSeptember 19 - September 26 - Tybee Island, GASeptember 26 - October 3 - Telluride, COOctober 17 - October 24 - Nags Head, NCOctober 24 - October 31 - Central Coast, CAOctober 31 - November 7 - New Smyrna Beach, FLOctober 31 - November 7 - Fort Morgan, AL (couples only)

Emergency Contact

Please list a person that will not be attending the retreat with you as an emergency contact for you while attending the retreat.

Emergency Contact Name

Emergency Contact Address

Emergency Contact City

Emergency Contact State AA AE AK AL AP AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NP NV NY OH OK OR PA PR PW RI SC SD TN TX UM UT VA VI VT WA WI WV WY

Emergency Contact Zip

Emergency Contact Phone

Emergency Contact Relation

Information for Retreat Leaders

The Retreat Leader will arrive at the retreat a day early and will have the volunteer house set up for your arrival. Please let the leader know about you and your preferences.

Your breakfast/snack food choices

Food limitations, special dietary requirements or other information?

Let us know how you are traveling to the retreat and estimated time of arrival. If you are flying, please email kathy@littlepink.org your travel itinerary. Please note that if you are arriving earlier than the check in date for your retreat, housing is NOT guaranteed.

Arrival Date

Estimated Time to Check In

Travel TypeCar/DrivingFlyingTrainOther

Confirmation

Confirm for 2026Yes