BreastCancerStories.com

To create your own website to write and share your story, please provide us with the following information. Once reviewed, you will receive a confirmation email with further instructions (typically within 24 - 48 hours). *

* To ensure this site is not being misused, we must review your information prior to setting up your personalized website.

IMPORTANT DISCLAIMER: Aside from the answers you provide regarding your breast cancer history, the only personal information that will be publicly displayed as a part of your story is your first name and the State that you live in. The remaining information is strictly for BreastCancerStories.com's informational purposes and will not be shared or made public in any way.

Terms of Use
BreastCancerStories.com can not be held not liable for any information you include in your personal area of the site. Please read our complete Terms of Use before you continue.

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Administrative User Name and Password
Create a user name and password to login to your website and upload chapters and photos or to update your personal information.

* The Username you select will also become a part of your website address (for example: www.breastcancerstories.com/username) so please select it carefully.

Username *		Usernames must be 6-30 characters and contain no spaces.
Password *		Passwords must be 6-12 characters. No punctuation or spaces allowed.

Personal Information

First Name *
Last Name *
Address
Address 2
City *
State *
Zip
Country *
Phone *
Email *
Gender *
Age When Diagnosed *
Age Today *
Type of Breast Cancer *
Stage of Breast Cancer *
Type of Treatments *	HINT: To select more than one option, press the CTRL key and keep depressed while left-clicking each option you'd like to choose.
Type of Medication *
Keep story private?	Private Password:
Enter the code as it is shown:

QUICK INSTRUCTIONS:

Please allow 24 - 48 hours for your story to become live - you will receive additional instructions via email.

To select more than one option when filling out the form, press the CTRL key and keep depressed while left-clicking each option you'd like to choose.

The only personal information that will be publicly displayed as a part of your story is your first name and the State that you live in.

IMPORTANT DISCLAIMER: BreastCancerStories.com does not endorse any products, treatments, medications, physicians, or treatment facilities that may be mentioned or recommended within the stories on this website. Any such suggestion by a story writer is of their own doing and has no relation whatsoever with BreastCancerStories.com, its staff or Board of Directors.

“We must all band together and hang tough in this fight against cancer.”