Write Your Story - AMEND USA

Please review your rights and answer the questions in the form below to submit your written story. Each box has a limit of 5000 characters which is approximately 5-7 paragraphs. For ease of use we suggest you prepare your responses in a separate document, then copy and paste them into the boxes below. We ask that you do not include the name of specific doctors or clinicians, though you are welcome to include the name of hospitals or institutions. Thank you for sharing your story with us.

First Name *
Last Name *
Street Address
Apartment, suite, etc
City
State/Province
ZIP / Postal code
Country
Email Address *
Confirm Email Address *
Phone
Social MediaPlease input your social media information so we may tag you when your story goes online.
What type of MEN or other condition are you living with?
Please describe your journey. What challenges have you faced, what helped you overcome them, and how are you doing today?0 / 5000
How has AMEND USA supported or impacted your journey?0 / 5000
What would you tell someone who just got diagnosed?0 / 5000
Rights Verification *
By checking this box I certify that I have read the Participant & Publication Rights, enumerated below, understand my rights, and agree to the terms listed and that I am age 18 or older.

Voluntary Participation I understand that sharing my story is entirely optional. Choosing not to sign this form will have zero impact on my eligibility for programs, support groups, or medical resources offered by this organization.

Right to Review: I have the right to request a review of the final edited text version of my story before it is published externally.

Right to Revoke: I can cancel this authorization at any time by sending a written notice to info@amendusa.org. I understand that while the organization will immediately stop using my story in new materials and take down digital posts, it cannot recall print items already distributed or media already published.

Publishing Rights: By submitting content, you grant AMEND USA a non-exclusive, royalty-free license to use, publish, and edit your submission in any format for our organizational purposes.

Please indicate how you would like your identity to be displayed publicly * *
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