Share Your Story

The Skin Cancer Foundation is always looking for individuals willing to share their personal skin cancer experiences. Please fill out the form below to share your story. Select stories may be shared on the Foundation’s website and/or Facebook page.

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* 1. First Name

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* 2. Last Name

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* 3. Contact Information

Address 1:

City/Town:

State/Province: *

ZIP/Postal Code:

Country:

Email Address: *

Phone Number: *

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* 4. Gender

Female

Male

Share Your Story

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* 1. First Name

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* 2. Last Name

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* 3. Contact Information

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* 4. Gender

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* 5. Ethnicity

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* 6. Skin Color

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* 7. Date of Birth (MM/DD/YYYY)

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* 8. What type of skin cancer did you have?

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* 9. How did you learn that you had skin cancer?

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* 10. What is the current state of your skin cancer? Are you in treatment for it?

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* 11. Do you have a history of tanning outdoors or using tanning beds?

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* 12. How was your skin cancer treated?

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* 13. How did your diagnosis change your behavior? For example, did you start practicing sun protection or stop tanning?

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* 14. Is there anything else that you would like to share?

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* 15. I am willing to share my story in the media.