A consortium of non-profit Lung Cancer Patient Advocacy Organizations, individuals, and the International Association for the Study of Lung Cancer (IASLC) are collaborating on a joint public awareness campaign for Lung Cancer Awareness Month – November 2016. A critical part of this campaign is to share and widely promote the stories of lung cancer survivors, caregivers and families of those who have been diagnosed with lung cancer.
If you are an organization partner participating in the LCAM Campaign, please use the form below to submit your organization description, logo and landing page.
Please complete the form below to participate and share your story and photos. If you have video to share, or content that is larger than the maximum file size of 16 MB, please email us at email@example.com.
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By clicking above, you agree to allow IASLC and the LCAM campaign to use all information submitted in advertising, print and digital and all other formats.
I hereby grant permission to the rights of my name and information submitted, images, likeness and voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Photographic, audio or video recordings may be used for promotional, advertising or educational purposes to promote awareness about lung cancer. Uses may include, but are not limited to: print or online advertisements, banner ads, social media advertisements, video presentations, conference presentations, educational presentations or courses, informational presentations, on-line educational courses, educational videos; By signing this release I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public informational or advertisement setting.There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. This release applies to information, images or video submitted on this form only.
By submitting this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for informational or promotional purposes.
We thank you for your participation in Lung Cancer Awareness Month!