EmailMeForm
Share your story
Thanks for your interest in sharing your story with Cancer Society Auckland Northland.
Please complete this form so we may get in touch with you regarding your story.
Please note, we will not publish any information you submit on this form without your approval. This form will simply be used to provide us with background information about you.
Name
*
First
Last
Email
Phone
*
How have you been involved with Cancer Society?
*
Please select
I have used Cancer Society services
I'm a supporter of someone with cancer
I'm a staff member
I'm a volunteer
I'm a donor
Other
Give a brief summary of your story or experience with cancer
If you would prefer for us to contact you directly about your story, please leave this blank and ensure you have provided an email address or phone number above.
Would you be okay with someone from Cancer Society contacting you about your story?
*
Yes
No