Please fill out our application form to become a participant in Head to Hollywood, a.k.a. an "H2H Star."

Selection into the H2H program is open to brain tumor survivors of all ages. The H2H program is not a contest or a sweepstakes, but rather a patient care program. Each "H2H Star" can be accompanied by one family member/friend. H2H selects patients year-round. If you are selected, an H2H representative will contact you. Please do not fill out more than one application, as only one application will be considered per person.

(All fields are mandatory, unless noted as optional.)