STORY/IMAGE SELECTION CRITERIA: At the American Cancer Society, Inc. (ACS), we believe all people should have a fair and just opportunity to live a longer, healthier life free from cancer regardless of how much money they make, the color of their skin, their sexual orientation, gender identity, disability status, or where they live. When we choose stories to highlight publicly, we make efforts to ensure that there is diversity of representation. Please let us know, by marking your selection below, whether you consent to our using this sensitive information as selection criteria for using your story and/or image.

I hereby irrevocably grant in perpetuity to the American Cancer Society, Inc. (ACS), its legal representatives or assigns, affiliates (including, but not limited to, the American Cancer Society Cancer Action Network, Inc.) and those acting under its permission and upon its authority, or those for whom American Cancer Society, Inc. (ACS) is acting, the absolute right and permission to:

(a) Demographic Data Consent: I authorize ACS to use my demographic information as story and/or image selection criteria.

(b) Health Data Consent: I authorize ACS to use my health information as story and/or image selection criteria.