Survey - Share Your Story - Pancreatic Cancer Action Network

Share Your Story

Thank you for offering to share your story with the Pancreatic Cancer Action Network community. Stories help provide hope to others facing pancreatic cancer and their loved ones as well as help illustrate resources available to them.

Please enter your contact information.


*	First Name: Required
*	Last Name: Required
*	Email: Required
	City:
	State/Province:
	Phone Number:
	If you respond and have not already registered, you will receive periodic updates and communications from Pancreatic Cancer Action Network.
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*

Question - Required - What is your connection to pancreatic cancer?

Question - Not Required - Have you interacted with any of the following Pancreatic Cancer Action Network services? (Please select all that apply.)

	Patient Central (call center)
	Educational events (lectures, seminars, webinars)
	Survivor and Caregiver Network
	Know Your Tumor
	Clinical Trial Finder or a personalized clinical trials search through Patient Central
	Patient Registry

*

Question - Required - How has pancreatic cancer touched you? What has your experience been with Pancreatic Cancer Action Network services? (Please limit to 650 words)

Please note: If your story is published, we are not able to share any specific information about hospitals, doctors or treatment in your story.

By submitting this I agree that the Pancreatic Cancer Action Network may post my story and photo on the Pancreatic Cancer Action Network website, newsletter, social media and/or other promotional materials. I also agree that the Pancreatic Cancer Action Network may contact me to follow up about my story.

By submitting, you will receive periodic updates and communications from the Pancreatic Cancer Action Network. You can change your subscription or unsubscribe at any time. All stories are subject to review and editing by the Pancreatic Cancer Action Network. Only select stories will appear on the Pancreatic Cancer Action Network website.