K4C Cuff Donation Form | Lema J Design
Custom cuffs now offered in extended lengths! Option available at checkout.

Donation Form

Lema J designed a Special Edition Karma for Cara Cuff, in Cara’s favorite orange color. For each special edition sold, a second cuff is donated as a gift of love and hope to a leukemia patient. If you know of a patient undergoing leukemia treatment whom you think would like to receive and wear a Karma for Cara Cuff, please complete the Form below. We look forward to hearing the stories of the brave women who receive these cuffs and that they feel the same love, joy and empowerment that we feel in designing, making and giving them.

Your Name

Your Email

Family Member/Friend Name

Family Member/Friend Email

Family Member/Friend Phone Number

Family Member/Friend Shipping Address

Family Member/Friend Story

Specify the age of the individual and any additional information you’d like to share

Hospital where they are being treated

Is there a contact at the hospital who might help us identify other patients who might want a cuff?

May we use your name in a short mention on our website as the person who suggested the patient?