SBC & Me Form

SBC & ME

The voice of a 1000 faces campaign for secondary breast cancer.

During Breast Cancer Awareness Month we want to highlight how many people are affected by secondary breast cancer and share real people's experience of this disease.

It is estimated that there are 35,000 people in the UK living with secondary breast cancer and that 1,000 lose their lives to the disease every month.

We want patients, families, friends, nurses, doctors, researchers, campaigners and carers affected by secondary breast cancer to add their voice to #SBC&ME and tell us their story.

Please submit your photo and information below and we will share everyone's image, name, location and how secondary breast cancer has affected them as part of the campaign.

Your SBC & ME Submission

Your Photo

Please submit a headshot to include in the campaign montage. Your headshot will appear in a montage of others similar to the example above. (required) Max 10 MB

Your Details

First Name (required)

Last Name (required)

Location (required)

Email address (required)

Telephone number (required)

Secondary Breast Cancer and You

If you are not a patient, please tell us how SBC affects you? max 1000 characters (approx 200 words)

If you have secondary breast cancer please answer the below questions so we can share this alongside your picture:

Date of diagnosis

Current treatment line max 1000 characters (approx 200 words)

How does secondary breast cancer affect your life? max 1000 characters (approx 200 words)

What advice would you give to someone newly diagnosed? max 1000 characters (approx 200 words)

Please confirm if you would be happy for us to contact you for more information about how secondary breast cancer has affected you.

Marketing Permissions

If you wish to receive newsletter and updates from Make 2nds Count please tick here.

Consent form for photography/filming

I have read and understand the conditions and consent to my images being used as described.

During Breast Cancer Awareness Month we want to highlight how many people are affected by secondary breast cancer and to do this we wish to share real people's photos and experience of this disease.

Make 2nds Count (“the Charity”) will use the photographs and information supplied for the BCAM 1000 voices campaign including both internally and externally to promote the Charity. These images could be used in print and digital media formats including print publications, websites, e-marketing, posters, banners, advertising, film and social media.

I understand that some images or recordings may be kept permanently on the Make 2nds Count website once they are published and be kept as an archive by the Charity.

Make 2nds Count is committed to processing information in accordance with the General Data Protection Regulation (GDPR). The personal data collected on this form will be held securely and will only be used for administrative purposes.

Your rights
You have the right to request to see a copy of the information we hold about you and to request corrections or deletions of the information that is no longer required. You can ask the Charity to stop using your images at any time, in which case they will not be used in future publications but may continue to appear in publications already in circulation.

You have the right to lodge a complaint against the Charity regarding data protection issues with the Information Commissioner’s Office (https://ico.org.uk/concerns/).

Home
SBC & Me Form