Share Your Story

Your story matters. If you’re living with pancreatitis or caring for someone who is, your experience can inspire and empower others who are going through the same thing. That’s why we want to hear from you! Share your story with us by filling out the form below.

Share Your Story Form

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Name
We will never share your email. We will only use this information if we need to contact you about your submission.
We will never share your phone number. We will only use this information if we need to contact you about your submission.
What is your connection to pancreatitis?
Things to consider sharing include: how you were first diagnosed, how your condition has progressed, how pancreatitis impacts your daily life, what has helped you manage your condition, what activities do you enjoy with chronic pain, how people have supported you, what hopes do you have for pancreatitis patients, how you hope your story will help others.
Optional
Optional
Optional
Click or drag files to this area to upload. You can upload up to 5 files.
Only submit images that feature you and those you have legal guardianship over. By submitting these images, you agree that you hold all rights to them and your submission does not infringe or violate any trademark, copyright or privacy rights of any third party.
By selecting "Yes," you grant Mission: Cure permission to tag you in social media posts that feature your story. If you prefer not to be tagged, select "No."
I hereby grant Mission: Cure permission to use my submission and my or my child’s likeness for use on Mission: Cure’s website, newsletter, social media, and/or other promotional materials, without payment or any other consideration. Mission: Cure will use my story and photos to help its efforts to develop effective treatments and improve the lives of people suffering from pancreatitis. I understand that Mission: Cure is a nonprofit organization, and that my submission will not be used for any commercial purpose. I also agree that Mission: Cure may contact me to follow up on my story. I am aware that Mission: Cure may not be able to share any specific information about hospitals, doctors, or treatment in my story. I am aware that Mission: Cure may edit my submission before publication for the purpose of clarity. I hereby irrevocably authorize Mission: Cure to publish the attached content and photographs for the purposes of publicizing Mission: Cure's programs or for any other lawful purpose. I hereby hold harmless and release and forever discharge Mission: Cure from all claims, demands, and causes of action which I have or may have by reason of this authorization. Mission: Cure will not publish the identity of any minor(s) pictured in the photographs provided. I am 18 years of age and am competent to contract in my own name. I have read this release before submitting this form and I fully understand the contents, meaning, and impact of this release.
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