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Dear Applicant,

Thank you for your interest in becoming a Meljourne® Woman. At Meljourne® Media, we understand that sharing the details of a traumatic experience can be very difficult, but we respectfully request that you include as many details as possible in your responses to better assist us in our selection process.

We look forward to being inspired by your journey!

Sincerely,

The Meljourne Team


All fields with an (*) are required. Responses should be between 100-2,500 words in length.

First Name: *
First Name:
Mailing Address: *
Mailing Address:
Daytime Phone Number: *
Daytime Phone Number:
(EX: specific actions/behaviors, choices, strategies,etc.)
If you are selected to be a Meljourne Woman, this organization will receive a portion of the proceeds from the sale of your personal collection.
(Check Box) I have read and agree to Meljourne Media’s Privacy Policy and Terms and Conditions. *