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.

First Name

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* 1. First Name

Last Name

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* 2. Last Name

Contact Information

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* 3. Contact Information

Gender

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* 4. Gender

Ethnicity

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* 5. Ethnicity

Skin Color

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* 6. Skin Color

Date of Birth (MM/DD/YYYY)

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

What type of skin cancer did you have?

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

How did you learn that you had skin cancer?

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

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

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

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

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

How was your skin cancer treated?

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* 12. How was your skin cancer treated?

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

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

Is there anything else that you would like to share?

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

I am willing to share my story in the media.

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

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