"I have a whole new perspective on life and
my place in it."
— Participant

RETREAT APPLICATION

Adult men who are in treatment for or recovery from all forms of cancer are eligible to
attend a Reel Recovery retreat. All retreats are free to the participants; Reel Recovery
provides all meals, lodging and fishing equipment. Participants are responsible for
their own transportation to the retreat location, and may be required to purchase a fishing license. A signed Medical Release from a physician must be received prior to the selected Retreat.

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Retreat Location/Date: (please select)		Graham TX: April 15 - 17 Gravette AR: April 19 - 21 Loveland CO: May 5 - 7 Henryville IN: May 17 - 19 Altamont UT: May 24 - 26 Boiling Springs PA: June 7 - 9 Basalt CO: June 11 - 13 Traverse City, MI: June 29 - July 1 Markleeville CA: July 20 - 22 Mackay ID: July 30 - Aug 1 Missoula MT: August 13 -15 Elkton OR: August 25 - 27 Altamont UT: Aug 31 - Sep 2 Flippin AR: October 19 - 21 Fall River Mills CA: October 27 - 29 Boerne TX: November 7 - 9 not sure - please contact
Applicant Name:
Address:
City, State ZIP
Daytime Telephone:
Evening Telephone:
Email:
Fax:
Emergency Contact During Retreat
Emergency Contact Phone Number
Birthdate:
Occupation:
How did you hear about Reel Recovery?
Please describe your experience with cancer (date of diagnosis, type of cancer, treatment, current status)
Do you have any physical restrictions and/or special needs?
Please tell us any issues or topics you would like to discuss at the Retreat:
Do you have any dietary preferences or requirements?
Do you have any previous fishing experience?
Have you ever attended a support group or retreat before?		Yes      No       If so, please describe:
Please feel free to provide any additional information:

You can also email us at: info@reelrecovery.org for more information.

Thank you for your interest.