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Save your spot
for a new kind of wellness event - coming Fall 2023!
Share Your Story
Ignite: Share Your Volunteer Story
Whether you are a survivor, spouse, a friend or a caretaker, you have a unique story. By sharing your story, you serve as both a source of inspiration and a reminder to other young women with breast cancer and their co-survivors that they are not alone. Feel free to share helpful tips or things you wish you knew when you were diagnosed. Please refrain from promoting a product or company. Any promotional information will be removed before your story is published.
To submit your story, please complete the form below. Contact and demographic information will not be shared online or with third parties.
I am submitting a:
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Survivor Story
Co-Survivor Story
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Phone Type
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Phone Number
###-###-####
Gender:
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Sexual Orientation:
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The ethnicity/ race I most closely identify with is:
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What is your relationship to the survivor?
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What is the name of the survivor/thriver?
What age were you diagnosed?
What was your diagnosis date?
MM/DD/YYYY
What was the cancer stage at diagnosis?:
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None
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
With which type of cancer were you diagnosed?
ER+
Her2+
Inflammatory
Paget's Disease
PR+
Triple Negative
Triple Positive
Other
What kind of treatment did you receive?
Chemotherapy
Hormone Therapy
Targeted Therapy
Radiation
Lumpectomy
Mastectomy
Double Mastectomy
Reconstruction
Hysterectomy
Other
Are you a healthcare provider?
Please select...
Yes
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Survivor or Co-Survivor Story
We recommend that you type or cut and paste your story here, which should be approximately 450 words. You can include how and when you and your loved one were diagnosed with breast cancer, the treatment process, sources of support (friends and family, YSC or other community resources), challenges and fears, what you are doing today and anything else that you think will help other young women affected by breast cancer.
Photo
Files must be less than 5MB. Allowed file types: png, gif, jpg, jpeg.
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