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