Your Story

YOUR STORY

* Indicates required field

Name *

First

Last

Email *

My name is ________ [1] and I have ________ [2]. Living with / having ________ [2] is difficult because ________ [3].

[1] *

[2] *

[3] *

Tell us more about your personal experience with your health condition. (Minimum 100 words) *

Tell us why you think more research is important and what you hope research will accomplish. (Minimum 50 words) *

We would like to display a photo of you on the STEM Biomedical website alongside your story. Please send a photo we can use to yourstory.stembiomedical@gmail.com.

. *

I have emailed a photo of myself to yourstory.stembiomedical@gmail.com

"YOUR STORY" TERMS AND CONDITIONS

By clicking the checkbox below, I confirm and agree to the following:

I am over the age of 18.
If I am filling this form out on behalf of someone who is not over the age of 18, I am their legal parent/guardian and have the right and permission to do so on their behalf.
the above information along with my full name and photo can be used and displayed online by STEM Biomedical at www.stembiomedical.org and/or on the STEM Biomedical social media pages.
If I am filling this form out on behalf of someone who is not over the age of 18, the above information along with the full name and photo provided of the person for whom I am the legal parent/guardian can be used and displayed online by STEM Biomedical at www.stembiomedical.org and/or on the STEM Biomedical social media pages.

Terms and Conditions Agreement *

I have read, confirm, and agree to the "YOUR STORY" Terms and Conditions outlined above.

Submit