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Share Your Story

Share Your Story!!!

Please be sure to fill out all the required information and give as much detail as possible.
We will follow-up with you to confirm receipt. Thank you!

First Name:*
Last Name: *
Phone Number: *
Email Address: *
Specific Type Of Cancer: *
Your Story: *
What Contact Information Would You Like To Include With Your Story? (i.e. name, email, phone #, etc.): *
Would You Like To Join Our SURVIVORS E-Mail List?			Yes Please!No Thank You.
I Agree			By submitting this form, I authorize My Hope Bag to use my breast cancer survivor story on their website and in print for the purposes of encouraging other women who are going through breast cancer. I acknowledge I have not received payment in exchange for my story and offer it by my own free will. Should I ever change my mind about my story being a part of My Hope Bag, I agree to notify them in writing. With the exception of formatting and slight grammatical corrections, my story will be used exactly as I submitted it.

If you'd rather email your story, please send it to info@myhopebag.com. Be sure to include your name, contact info, your story and the authorization form below. Thank you!

Authorization/Release Form

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