Submission for Faces of YLC – Young Lung Cancer Initiative

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Submission for Faces of YLC

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Information of person you would like to honor

Name of Tribute

First

Middle

Last

At what age were they diagnosed?

Example put "40" for "Diagnosed at 40"

State

If you do not live in the United States, please list below where you are from

Photo upload

Click or drag a file to this area to upload.

Please upload a good headshot of their face with nobody else in the photo.

Please share your story

Submitter's name and information

Name

First

Last

Phone

Is there anything else you'd like to share?

Do you have permission to share?

By ticking "yes" and submitting this form you are confirming that you either represent the family of this tribute or have their families permission to request their story to be posted on our website.