If you would like to share your personal experience of cancer we would love to hear from you.

Hearing real life stories may provide hope and support to people who may be going through a difficult time, encourage people to get any symptoms checked out, go for the screening they had been putting off, or highlight the importance of healthy lifestyle choices in lowering cancer risks. Your stories help us engage with the public and may encourage people to donate or take part in one of our fundraising events, therefore supporting our work in reducing the impact of cancer on all Territorians.

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* 1. Please fill in the below information.

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* 2. Are you a:

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* 3. If you are a cancer patient or cancer survivor please give us some details.

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* 4. Please tell us your story in your own words, including what you have been through and why you would like to share your story.

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* 5. Have you participated in any of the following? (please select all that apply)

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* 6. I am happy for Cancer Council (Cancer Council NT and Cancer Council Australia) to share my story with the public.

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* 7. I am happy for Cancer Council NT to follow-up with me and/or my family in the future.

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* 8. I am happy for Cancer Council NT to use any images I supply in Cancer Council marketing and publicity.

(If yes, please send an image of yourself to healthpromotion@cancernt.org.au. If you’re getting in touch about a friend or relative’s experience of cancer, please seek their permission if possible and send us photos of the two of you if you can.)

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* 9. I am happy for Cancer Council NT to contact me about participating in upcoming photo shoots or television campaigns.

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* 10. Privacy Collection Statement

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