In My Own Voice Interest Form

African-American women are often diagnosed younger, at later stages and with more aggressive breast cancers when the prognosis is poor, which contributes to nearly 40% higher death rates than white women. These disparities are especially salient as it relates to metastatic breast cancer (MBC); African-American women living with MBC face unique challenges associated with this disease. Despite these facts, African-American women are often underrepresented in the conversation on the unique needs, priorities and barriers to equitable treatment of women living with MBC.

To address this gap, we are hosting an event called In My Own Voice (IMOV), for African-American women living with MBC in Los Angeles, California on August 7-8, 2019. This intimate gathering will share information about the latest advances in scientific research and clinical treatment specific to MBC with participants and engage participants in conversations to gain insight into their unique needs, barriers they face, and possible solutions to inform Komen’s efforts to address disparities in racial and ethnic breast cancer outcomes.

Tentative Schedule:
Wednesday, August 7, 2019
1:00 p.m.-8:00 p.m.   

Thursday, August 8, 2019
Breakfast (optional): 7:30-8:45 a.m.
Meeting/focus groups: 9:00 a.m.-1:00 p.m.

Participation:
  • Priority given to those living in the Western US
  • Must be an African-American woman living with MBC
  • Must be willing to share your contact information and a brief bio with Komen staff and other women attending the event

We have a limited number of spots for African-American women living with metastatic breast cancer to attend the event.  If you are interested in participating please complete the following questions. 


Participants will incur little to no costs for attending this event, and individuals selected will receive detailed information about travel and meeting logistics. Since we have a limited number of spaces for participants attending this event, we ask that you complete the following interest form. We will notify you mid-July if you have been selected to participate. Thank you in advance for your time.

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* 1. Contact Information

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* 2. How old are you?

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* 3. Please confirm that you are an African-American woman living with metastatic breast cancer.

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* 4. How long have you been living with metastatic breast cancer?

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* 5. Will you need to travel with a caregiver?

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* 6. Please provide a short bio about your diagnosis with metastatic breast cancer (MBC).

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* 7. Please upload a picture to go with your bio.

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* 8. How comfortable do you feel voicing your opinions and sharing barriers and challenges you've faced living with MBC?

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* 9. Are you involved in any support groups?

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* 10. Are you interested in becoming more involved with the Susan G. Komen Los Angeles or Orange County Affiliate or Komen Headquarters?

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* 11. Are you okay if we share your name and email address with the Komen Affiliate located nearest you?

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* 12. A program book will be developed with your contact information (i.e. name, city/state, email) and bio and sent out to other IMOV attendees prior to the event. We hope this will allow you to learn more about each other before arriving at IMOV.

Please indicate whether you agree or disagree with sharing your information with Komen staff and IMOV attendees.

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