Mattress April 2024 E-Sign

Please review the submitted information and sign below.

I understand that I am applying to participate in the UBCF gifts-in-kind giveaway which provides those affected by breast cancer the opportunity to receive donated Product/s during an event held at a location in Warwick, RI.

I understand and agree the processing of my application to attend United Breast Cancer Foundation’s (UBCF) Tempur-Pedic® Mattress and Pink Bag Event® may take up to 10 (ten) business days.

I understand and agree that I will be notified via email and/or text message regarding the status of my application once it has been processed. 

I understand and agree that UBCF only accepts completed applications in 1 (one) online application, and only 1 (one) application per household

I understand and acknowledge that applications are processed and approved on a first come, first served basis, and by submitting my application I am not guaranteed to be approved.

I accept the product/s in "as is" condition. UBCF assumes no responsibility for the Product's present or future condition and I hold harmless UBCF, and its related and affiliated individuals and donors, from any injury or liability which may occur directly or indirectly as a result of my use of the Product/s. UBCF is not the manufacturer of the Product/s. I acknowledge that no representations are being made by UBCF as to the condition, use or maintenance of the Product/s. I state that I have the opportunity to inspect the Product/s and that I believe in my sole judgment that the Product/s is useful and acceptable to me. I acknowledge that the Product/s may be in new, refurbished, or used condition

I agree that no goods, services or other benefits were exchanged in return for the Product/s. I may not sell, trade, barter or otherwise distribute the Product/s to any other person or entity. I shall utilize the Product/s solely for my personal use.

I understand that the event will take place on April 27, 2024, between 8 AM to 5 PM EST (subject to change) in Warwick, RI and that if approved I will be assigned an appointment (pick-up time) between the hours of 8 AM and 5 PM EST that cannot be changed. I will bring the approval information and photo identification with me and show it as requested or, notwithstanding having been approved, I will not be allowed to participate. At the event I will conduct myself properly and will follow the reasonable instructions of UBCF

I would prefer the following time range if possible but recognize I might be assigned another time

First Name

Last Name

Birth Date





US States





When were you diagnosed with Breast Cancer? 

Are you currently under treatment for Breast Cancer

Are you in remission from Breast Cancer

total number of people in your household

total number of children 18 or under in your household

Total annual household income (wages, social security, unemployment, alimony, child support, etc.)

UBCF is offering Queen size Tempur-Pedic® mattresses

How did you hear about UBCF?

Please share with us how this donation would support you on your breast cancer journey.

Would you agree to share your experience with UBCF?

I acknowledge that I will pick up my product/s on the day of the event.

IMAGE RELEASE. For good and valuable consideration, the receipt and sufficient of which I hereby acknowledge, I give and grant the United Breast Cancer Foundation (UBCF), and all those acting on its behalf, the absolute right and permission, with respect to the photographs and videos UBCF has taken of me and testimonials I have submitted to UBCF (the “Content”), to use the Content in connection with furthering the mission of UBCF in any and all ways, formats and media UBCF determines in its sole discretion. I hereby release, discharge and agree to save UBCF, all those acting on its behalf and all those for whom UBCF is acting, from any and all claims and demands arising out of or in connection with the use of the photographs, video, and or testimonial, including any and all claims for libel. I am of legal age and have read the foregoing and fully understand the contents thereof. Please select one: 

I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.

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Signature Certificate
Document name: Mattress April 2024 E-Sign
lock iconUnique Document ID: 6e017ccdca6a8fdd37184960314da97a16258a28
Timestamp Audit
February 21, 2024 3:23 pm EDTMattress April 2024 E-Sign Uploaded by United Breast Cancer Foundation - IP