Questions for a Survivor

We are looking for stories of hope and inspiration. Stories from all who have been touched by colon cancer.

Just answer a few questions below (our writers will draft a story from your responses), or you may compose the story yourself answering those questions and submit the text in the last field below.

Stories should be written in the first person, from your point of view.

Your Name (required)*
First Last
Tribal Affiliation
Your Email
Address
City State
Phone Number (required)*
Give us some background on who you are and what you do.
Do you have a history of colon cancer, or other cancers, in your family?
What effects has colon cancer had on you, your family, and your support network?
What words of wisdom do you have for another person who is fighting the disease?
Here's my story in my own words. (I understand GPTCHB writers may edit for length and will communicate with me any changes.)
Please submit 2-4 photos to share with your story. One of these photos should be of you. As well as an individual photo of your loved one. The remaining be group or active photos that help illustrate your story. (one required)*
Drop files here or

Accepted file types: jpg, jpeg, gif, png.
Please provide the name of any required photographer credits.
First Last
Have you created a video telling your story?
- Yes
- No
Do you use Facebook?
- Yes
- No
If yes, please provide YouTube, Vimeo, or other URL.
What is your Twitter handle?
What is your Instagram handle?
- By submitting my story and photo I grant permission to GPTCHB the rights to use submitted photographs and my story, portions of my story and quotes, in conjunction with my own name for the purpose of educating and screening for colorectal cancer. I waive any right inspect or approve the finished material. I understand that I shall not receive any compensation for use and I acknowledge that I have no interest or ownership in the material or its copyright. I warrant that I am 18 years of age or older and I have the right to enter into the agreement in my own name.
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Phone
This field is for validation purposes and should be left unchanged.

Questions for a Survivor

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