Enter the Surviving Idol Contest

Surviving Idol: Young Adults with Cancer Expressing Themselves

IMPORTANT: Before submitting online entry form (below) with video, download License/Release form (pdf) ,
read, sign and return it either by fax to: (818) 788-5260 -OR- by email to: info@survivingidol.com

Online Entry Form

* First Name:

* Last Name:

* Age:

* Diagnosis:

* Email Address:

* Street Address:

* City:

* State:

* ZIP/Postal Code:

* Country:

* Telephone:

* Category (select):

Vocal-

Instrumental-

Dance-

Video Description:

* Video File:

Your Story (if you would like to share something about your cancer experience):

To submit this form and upload your video, you must agree to the rules of the Surviving Idol contest as outlined here. You must further affirm that you are a cancer survivor. (Finalists whose diagnosis cannot be confirmed will be disqualified.) Please check the box below to indicate that you agree.

I agree*

* = required