Share your story – form

Thank you for volunteering to share your story. Please complete this form and one of the ICR's Media Relations team will be in touch shortly. If you have any questions you can email us ([email protected]) in complete confidence.

Personal details

Title

Title (if other)

First name

Surname

Gender

Ethnicity (why we ask for this)

Ethnicity (if other)

Year of birth (why we ask for this)

Postcode (why we ask for this)

Contact details

Contact phone number

Email address

Association to cancer

How have you been affected by cancer?

How affected (if other)

Please choose the type of cancer

Type of cancer (if other)

Please write a short summary of your story (suggested limit: 200 words), don't worry if you can't fit everything in, we'll be in touch for more information.

Permissions

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Are you happy to be contacted by the media team by phone?

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Would you like to receive quarterly email updates on how your fellow volunteers have helped raise awareness of the ICR’s research?

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I have read and understand the Institute of Cancer Research, London's Cancer Stories Privacy Statement

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Share your story – form

Personal details

Contact details

Association to cancer

Permissions

Why we ask for this information?

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