LCAM 2022 Social Media Card Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Use this form to submit your information for an LCAM Social Media card.

Please answer every question!

For the photo, you have 2 options:

1. Neutral expression photo of just you.

2. Emotive shot of you living your best life, or being with the people you love.

For your three statements:

- Brevity is key. A short fact like "I am a father/mother" or "I love live music" is perfect.

- It can be about anything

We need your email address to contact you when your card is ready, or we might need to clarify some information. We will not share your address, or store it once the LCAM campaign is finished.

Please remember to email your chosen photo(s) to communication@alkpositive.org!

Email *

Here are 2 examples of what the card might look like.

Please enter your full name as you would like it to appear on the card *

Please select which social media sites you would like cards for *

Twitter and/or LinkedIn

Facebook and/or Instagram

Required

With permission, we would like to post some cards on our social media channels to help our LCAM campaign. Please let us know whether you are happy for us to share your card, or if you would rather we did not. *

I am happy for ALK Positive Inc and/or ALK+ International to share my card on social media.

I do not wish for my card to be shared.

Please tell us your Facebook handle. You can find this by going into Profile Settings. If you cannot find it, please tell us your name as it is on Facebook and we will try to find you. Please leave this blank if you do not wish to be tagged or do not use Facebook.

Please tell us your Twitter handle. Please leave this blank if you do not wish to be tagged or do not use Twitter

Please tell us your Instagram handle. Please leave this blank if you do not wish to be tagged or do not use Instagram

Please tell us your LinkedIn handle. Please leave this blank if you do not wish to be tagged or do not use LinkedIn

Please tell us the first fact about you. In the above example, this would be "I am a father", Ideally no more than 4-6 words. *

Please tell us the second fact about you. In the above example, this would be "I am a husband", Ideally no more than 4-6 words. *

Please tell us the third fact about you. In the above example, this would be "I have stage 4 lung cancer", Ideally no more than 4-6 words. *

Please tell us your location (City, State/Province, Country). This is optional, so please include if you would like it on your card.

Which charity logo would you like on your card? *

ALK Positive Inc

ALK+ International

Neither

Please tell us some additional information that will help us add context to the card.

1. Date and your age at diagnosis

2. Cancer stage

3. Current medication

Please tell us some additional information about you that might help us add some context to the card. For example:

1. You might love pets "I have 3 dogs"

2. A hobby or interest "I love golf" or "I love live music"

3. Something you love doing when not focused on cancer "I work as an anaesthetist" or "I love spending time with family"

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Catherine Gibbard. Report Abuse

Forms