Cook a Meal participant registration

Thank you for registering your interest in our Cook a Meal program.

Your incredible generosity will give country cancer patients, who are undergoing life-saving cancer treatment whilst staying at our Lodges, a much-needed night off from cooking, giving them a chance to unwind and socialise post-treatment.

Please fill in the registration form below to sign up.

Thank you for making a difference to the lives of West Australians impacted by cancer.

Participant details

Organisation(Required)

Date of participation

Name(Required)

Prefix First Last

Date of birth(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Emergency contact details

Name(Required)

First Last

Relationship(Required)

Phone(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Do you have any allergies, health conditions, medical treatments or disabilities that we may need to know?