Question Title

* 1. Name (as you would like it to appear)

Question Title

* 2. Email (in case we need to contact you)

Question Title

* 3. What Does the Dana-Farber Brigham Stem Cell Transplant Program Mean to You? 

Whether you are a patient, caregiver, staff member, community member, or donor, we want to hear from you! What does our adult stem cell transplant program mean to you? What message do you have for the transplant care team?

Question Title

* 4. Submit Your Photo 

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 5. I am 18 or older and understand that by submitting my photo and/or comments (“Content”), I’m giving to Dana-Farber Cancer Institute (“DFCI”) unqualified, absolute and irrevocable right and permission, without compensation and without right of prior notice, inspection, or approval, to use, reproduce, edit, exhibit, project, display, copyright, publish, circulate and/or sell or otherwise use my name and/or Content in still, single, multiple or moving images in which I may be included in whole or in part, or composite, and to circulate the same in all forms and media, in all domestic and foreign markets, for art, advertising, publicity, training, trade, competition of every description, commercial or other business purposes, in connection with promotional or fundraising events, and/or for any other lawful purpose whatsoever.  I also consent to the use of any printed matter in conjunction therewith. I represent that I have all necessary rights, consents, and permissions to submit my Content. I understand and agree that DFCI has the option, but not the obligation, to use my Content and that DFCI reserves the right to edit my comments for clarity and length.  By providing my email address, I consent to be contacted if DFCI has any questions about my Content and understand that DFCI will not use my email address for any other purpose. I confirm that I have read this authorization and hereby waive and fully and forever discharge Dana-Farber Cancer Institute from any claim, demand, or cause of action I or any persons or representatives acting on my behalf may have by reason of this authorization. 

T