Tell My Story Submission Form
Have you or someone you love been affected by lupus? Help us give encouragement to people across the country and around the world by sharing your story. It's stories like yours that provide freedom from pain and courage to others whose lives have been turned by lupus. Share your story by completing all fields in the form below.

What happens next? If your story is selected, you will be contacted about being interviewed. You may be asked to be featured in "Looped in Lupus Journeys," an in the works compilation of the stories of people living with lupus at all stages of the disease. These stories may also be featured in emails, newsletters, and on social media sites. If you or someone you know is affected by lupus, please share this resource, then find out more information at Facebook.com/TheLupusLiar.
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First Name *
Last Name *
Email address (We won't post your email address anywhere. It will be kept private UNLESS noted in the social media platform area.) *
*Your email address will not be shared on ANY social media platforms. This information is strictly confidential! We would like to note your city or county.
Address Line 1 *
*Your address will not be shared on ANY social media platforms. This information is strictly confidential!
City *
*Your address will not be shared on ANY social media platforms. This information is strictly confidential! We would like to note your city or county.
Can we publicly note your city or county? *
*Your address will not be shared on ANY social media platforms. This information is strictly confidential! We would like to note your city or county.
Telephone (Please enter only digits) *
We will never share your phone number. We will only use this number in the event we need to contact you about your submission.
Demographic Information
State *
Zip Code *
Country *
Share My Location *
By default, we like to share the City/State that you provide here within the story on our website. If you prefer to have your location remain anonymous please select the appropriate response.
Birth Date (MM/DD/YYYY) *
*We will never share your birthdate.
Share My Birthday *
By default, we like to share the birth date  (month and day only) that you provide here within the story on our website. If you prefer to have your birth date remain private please select the appropriate response.
Gender *
Race *
Feel free to share your social media platforms ONLY if you'd like to have those listed with your submission.
Share My Social Media Platforms
We would like to share the social media platforms that you provide here within the story on our website. If you prefer to have your social media platform information remain private please select the appropriate response.
Twitter Handle
Facebook Link
Give your story submission a title: *
Share Your Story! Write or paste your story submission here: *
Please keep your stories no more than four paragraphs long. Suggested Content: How and when were you diagnosed? When did your symptoms first begin?  How did your symptoms affect your every-day life? What kind of doctors do/did you see? What sort of exams do/did you have? Have you participated in any clinical trials or alternate therapies? What advice do you have for other patients who may be going through a similar journey? {*Copy/Paste this URL to upload your photo - https://www.dropbox.com/request/THgUudgzXLx943GuznZJ}
Is it okay if we publish your submission with your name? *
Required
Consent
You are giving The Lupus Liar, and its affiliates and licensees permission to use your Story. By submitting your story/photo, and clicking the checkbox below, you grant the The Lupus Liar and its affiliates permission to use your story, photo, name, and city/state (if provided) as part of online social media to increase lupus awareness. We will never publicly use your last name, email, and/or phone number without your permission. Your name and story may be published by The Lupus Liar LLC; its affiliates and licensees for others to read, however your personal information will not be shared or sold to third parties. Read our Privacy Policy.
*Note: You must be 18 years old or older to submit a story. Read the Consent Agreement.
*Copy/Paste this URL to upload your photo - https://www.dropbox.com/request/THgUudgzXLx943GuznZJ
Yes, I agree to all terms and conditions. *
Required
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