First Name*
Last Name*
Email*
Postcode*
Mobile*
What is your connection to pancreatic cancer? (select all that apply)*
I am currently being treated for pancreatic cancer
I am currently caring for someone with pancreatic cancer
I am a friend or family member of someone who has pancreatic cancer
I have lost someone to pancreatic cancer
I am worried that I may be at high risk of pancreatic cancer
I had pancreatic cancer
Other (please specify)
Specify your connection if not listed above
Enter Your Story Here
In your own words, tell us about your experience with pancreatic cancer. You might like to include how it began, what you or your loved one went through, how you navigated challenges, and anything you wish you knew that could be helpful for people currently going through this. Please keep your submission to 600-750 words.
Distribution Consent
Yes, I’m happy for my story and name to be included
Yes, but please keep my name private
No, please keep my story private
Are you happy for us to share your story on our website or in communications? ( i.e social media channels, e-newsletters, appeals, campaigns and promotional materials)
Comments