B Happy Questionnaire B the Difference

Please Tell Us About Yourself
Recipient Name*
First Last
Recipient Birthdate*
Recipient Gender
As listed on your photo ID
Recipient Cell Phone
If minor, provide guardian cell phone.
Recipient Email*
If minor, provide guardian cell phone.
Recipient Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you have NF1, NF2, or Schwannomatosis?*
At what age were you diagnosed with NF?*
Do you have any physical limitiations?*
Please be as specific as possible to help us properly plan.
Do any of your family members also have NF? If so, who?*

Additional Family Members Accompanying You On Your Trip
From experience, we know that NF not only affects the person afflicted but the other family members who make multiple sacrifices. Having said that, of the immediate family members living with you, who will be accompanying you on your B Happy trip? Trips are limited to a total of five people including the recipient.
Name
First Last
Relationship
Gender
As listed on your photo ID
Birthdate
Cell Phone
Email
- Add Family Member
Name
First Last
Relationship
Gender
As listed on your photo ID
Birthdate
Cell Phone
Email
- Add Family Member
Name
First Last
Relationship
Gender
As listed on your photo ID
Birthdate
Cell Phone
Email
- Add Family Member
Name
First Last
Relationship
Gender
As listed on your photo ID
Birthdate
Cell Phone
Email
Upload Family/Individual Photo
Please upload a family photo that we will share with your host.
File*
Max. file size: 192 MB.

Please Tell Us About Yourself