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Wanted: a Part-Time Experienced Fundraising Coordinator
Sweet Louise is seeking a Part Time Fundraising Coordinator (Auckland) to join our
team... could that be you? Find out more...

Currently Sweet Louise is able to offer services to those living in the Auckland, Northland,Palmerston North/Mid Central and Wellington regions, our aim is to provide services nationwide as resources permit.

Please pick your City/Town: *

Please select one of the following options:

I have been diagnosed with metastatic breast cancer and would like to register for Sweet Louise Services.

I have been diagnosed with metastatic breast cancer and would like to register to use Sweet Louise Journals and Forums.

Personal Details > Referring Heathcare Provider Details > Dependants Details > Confirmation

Personal Details

First name: *
Middle name:
Last name: *

Diagnosis: *
Date of birth: *
Ethnicity: *
Marital status: *

User Details

User name: *

Password: *
Confirm password: *

(Your user name and password will be required to log in as a Sweet Louise member)

(Minimum of 6 characters)

Contact Details

Country: *

City/Town: *

Suburb: *

Physical street: *

Post code:

Home phone:

Work phone:

Mobile phone:

Email address:

Preferred methods of communication: *

Home	Work
Mobile	Email

Click here if your mailing address is different from above

Mailing Address (If different from above address)

Physical street: *

or PO Box number: *

Country: *
City/Town: *
Suburb: *
Post centre: *
Post code: *

Personal Details > Referring Heathcare Provider Details > Dependants Details > Confirmation

2. Select your referring Healthcare Provider. For full service members, this may be your GP, Specialist, Oncologist, Radiologist, or Oncology Nurse. For members accessing journals and forums, this is your Oncologist.
We will need to confirm your eligibility with your provider.
To search, enter the first 3 letters of their first name or surname.

Search for your referring healthcare provider

Healthcare provider name:

(Enter at least 3 characters of your doctors first or last name)

OR Enter your Healthcare Provider and Healthcare Organisation details

Provider type: *
Name: *

Organisation name: *
City/Town:
Suburb:
Street address:
Phone number: *

Personal Details > Referring Heathcare Provider Details > Dependants Details > Confirmation

3. Tell us about your dependants (this will help us consider the needs of your family)
If you do not have any dependants, go to next step.

Dependants

Name	Date of birth	Gender

Personal Details > Referring Heathcare Provider Details > Dependants Details > Confirmation

4. Confirm details

Confirmation

I agree to the Terms & Conditions*

Please add any additional information that may be useful for us to know

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Wanted: a Part-Time Experienced Fundraising Coordinator Sweet Louise is seeking a Part Time Fundraising Coordinator (Auckland) to join our team... could that be you? Find out more...

Wanted: a Part-Time Experienced Fundraising Coordinator
Sweet Louise is seeking a Part Time Fundraising Coordinator (Auckland) to join our
team... could that be you? Find out more...