* indicates required fields.
Email (will be kept private) *
Phone Number (will be kept private) *
I have participated in a Stanford cancer clinical trial
Someone close to me has participated in a Stanford cancer clinical trial
I am a researcher or medical professional
Your story: (will be shared) *
Would you like to add a photo to your story? Jpeg format (will be displayed)
Yes, I would like to have my story published online and/or in print. I understand I am submitting my text and uploaded photograph(s) and/or video(s) on Stanford Medicine’s Cancer Clinical Trials Office (“Stanford University”) website. I understand this information may be viewed by any individual or company that visits the Stanford University website. I hereby waive any future right to inspect or approve the use of the text, images or recordings by Stanford University. I further waive all moral rights and any right to royalties or other compensation arising from or related to the use of the text, images or recordings that I am providing. I further acknowledge that this waiver is applicable in an unrestricted geographic area. Stanford University reserves the right to alter pictures, edit text, and to remove any submissions at any time and not all submissions will be published. If you have any questions about contributing your story, please contact email@example.com.
A copy of this submission form will be emailed to you.
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