BACC Silver Lining Insights
BACC is celebrating our 25 year anniversary and we would like to hear what impact BACC has had in your life! Please answer the questions on this online form or send us a video submission of your answers to events@bayareacancer.org. However you choose to answer these questions, please send us a photo of yourself to events@bayareacancer.org to go with your submission.

Your stories may be included in our 25th Anniversary Gala or other materials for years to come. Thank you in advance for your help with this project!
Email address *
How long have you been a part of the BACC community?
Your answer
At what point in your treatment did you come to BACC?
Your answer
How did BACC make you feel when you first called or came in?
Your answer
What programs or services did you participate in or currently participate in at BACC? Do you have a favorite?
Your answer
How has BACC been a silver lining in your cancer experience?
Your answer
What is the greatest benefit you've received from BACC?
Your answer
Release Agreement
I grant permission to Bay Area Cancer Connections (hereafter BACC) to use photographs, videos, and my written statements; to use, transcribe, reproduce and distribute these materials in complete or partial form, in educational materials, publicity documents, newsletters, magazines, and exhibitions. I understand that these materials may be used in any and all forms, in print, publication, electronic transfer, video, CD-ROM, Internet or World Wide Web, and in any other media format now or hereafter known. I understand that the materials I have submitted may be subject to editing at the complete discretion of BACC. I hereby waive any right to inspect or approve the finished materials or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs. I hereby agree to release, defend, and hold harmless BACC, its officers, employees, agents, photographer, or designees from and against any personal or proprietary right, claims, damages, or liability arising from or related to the use of the materials I have submitted. I further stipulate and affirm that I am 18 years of age or older. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing; and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
Personal Information
Please provide your name as you would like it to appear next to your story
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Breast Cancer Connections. Report Abuse - Terms of Service