Chronic Market Art Cards for Chronic Illness
Thank you for your interest in participating in the Chronic Market's art card project for ME/CFS sufferers and other chronic conditions.  This project aims to raise awareness about ME/CFS -- particularly in its severe form, when can mean being permanently bedbound or housebound -- and mobilizing healthy allies (or fellow sufferers!) to create art cards for patients.

Please complete the following form to receive an art card. If you would like to refer someone to sign up to create art, please share this link
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Name *
Full street address, including country *
Do you suffer from ME/CFS and/or other chronic illness/disability? What level of severity? *
Email *
Social media handle/s if you would like to be tagged (instagram/facebook)
Is there anything you would like your art card match to try to incorporate (favorite image, an upcoming holiday, color, etc)?
Anything about your story you would like to share with your art card match? 
Please provide your birthday if you would like to potentially receive an additional card for your birthday.
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