Name *

First Name

Last Name

Would you like to be matched with someone who is currently your age (or similar), or some one with the same stage of cancer? *

Please match me with someone who is my age.

Please match me with someone who has the same stage as me on their melanoma journey.

I don't mind.

Please acknowledge the below with a tick *

I understand and acknowledge that Australian Skin Cancer Foundation will facilitate Melanoma Mates matches via email in the first instance, but is not responsible for any further contact or correspondence thereafter, and by agreeing to participate, you agree to communicate with your match.