Interest Form

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* 1. Enter your information

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* 2. In what country do you live?

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* 3. What best describes you?

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* 4. What type of gynecologic cancer(s) were you (or your loved one) diagnosed with?

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* 5. Please specify the general time frame (year) of diagnosis, treatment, and remission, if applicable.

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* 6. Which cancer treatments were a part of the care plan?
Please note participation in clinical trials or research.

(No need to be too specific or detailed. e.g., surgery, chemotherapy, radiation, immunotherapy, etc...)

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* 7. Based on your experiences, which key advocacy issues do you feel most strongly about or do you feel are illustrated in your own story?

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* 8. Please provide additional information or context about your experiences. You may choose to include challenges, successes, important aspects of your experiences, messages you want to share with others, why you want to share your story, etc…

Please provide as much detail as you feel comfortable. You may paste in hyperlinks to articles and videos where we can learn more, if applicable.

The information you provide on this form will never be shared without your express permission.

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* 9. Which of the following options are you comfortable with?

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* 10. Which of the following projects are you most interested in?

Please rank these options with 1 being your first choice.

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* 11. If you would like to share your social media information for collaboration and to potentially be tagged in our posts, please enter your handle, username, or URL.

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* 12. If you are not selected for an interview project at this time, are you willing to submit your story in writing (a blog post or other self-produced format such as video recording, photos, quotes, etc...) so that the IGCS could feature your story in their communications channels?

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