Share Your Story

Whether you or a loved one has been affected by skin cancer, you have a story to tell that can help others. Sharing your story can provide support and inspiration for others fighting skin cancer, and help communicate the importance of prevention and early detection of skin cancer.

First Name*:

Last Name*:

City:

State:

Patient Gender:
 Male Female

Email*:

 Please allow others to contact me, but keep my email address anonymous. Please do not allow others to contact me.

Upload a Photo:

Your photo will be posted with your story.

Relationship to melanoma/skin cancer *:
 I am a survivor. I lost a loved one. I have a loved one who has/had melanoma/skin cancer. Other

Patient year of diagnosis:

Patient age at diagnosis:

Type of Skin Cancer:
 Basal cell carcinoma Squamous cell carcinoma Melanoma - Stage I Melanoma - Stage II Melanoma - Stage III Melanoma - Stage IV Other

Your Story:

Additional opportunity:
 I am interested in sharing my story through media interviews or public speaking events.

Terms and Conditions*:
 I understand and agree to the Terms for Sharing Your Story.

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