We will contact you shortly with information about your hat.
If you do not hear from us within 24 hours, please call or email to make sure we received your order!
If you do not have the required referral card, please enter your
treatment center and/or support group information in the Notes section below
so that we can provide them with referral cards. If the referral card or treatment center
information is not included, it will delay delivery of your hat.
Item: Ben BM-J6
Items with an asterisk are required.
We value your privacy!
All information is confidential and is only for the purposes of contacting
you in connection with sending you the ConnieCap you want. We will not share
this information with anyone.