Become an Honored Hero

Iowa Chapter | 2700 Westown Pkwy., Suite 260 | West Des Moines, IA 50266 | (515) 270-6169
 
 
As an Honored Hero, you will have the opportunity to participate in as many LLS events as you would like and/or become active with some of the Patient Services programs.
 
Honored heroes are important to LLS fundraisers.  We encourage you to be as active as possible so that the fundraisers have a chance to meet you.  If you are unable to attend the events, we encourage you to send letters of support or call the fundraisers to provide encouragement and inspiration.  It truly makes a difference for them. 
 
If you would like to be a part of this remarkable program, please complete the following information.  We look forward to meeting you and wish you good health and happiness.
 
If you have any questions, please contact Keena Roberts, at (515)270-6169, (800) 327-1074, or Keena.roberts@lls.org.
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I hereby give permission for the use of my patient/family profile information, quotes, pictures, interviews, etc to be used by the following Leukemia & Lymphoma Society Programs. (Please select all that apply). *
Photography/Text Release 

I hereby authorize and permit the Leukemia & Lymphoma Society (LLS) or it authorized agent, without compensation therefore, permission to photograph, publish on the LLS Web site, (including the LLS online community and LLS Social Media venues), reproduce, record and use, with or without my full name* or the name of the person for whom I am the parent/guardian. This includes but is not limited to photographs, quotes and/or text, motion pictures, videotapes, website information or audiotapes of and/or by me or the person for who I am the parent/guardian.

 I release the Leukemia & Lymphoma Society from any and all legal liability that may arise from the release of information requested. I agree that all text, photographs, motion pictures, negatives, prints and transparencies, videotapes and audio tapes made of and or by me or the person for whom I am the parent/guardian by or for the Leukemia & Lymphoma Society, shall be the exclusive property of the Leukemia & Lymphoma Society which in its sole discretion may use this material as it sees fit.

 

Parent/Guardian Signature *
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Please note: No last names, addresses, phone numbers or emails will be shared unless you choose to do so yourself when asked.  If you are uncomfortable with any aspect of the program, but would still like to participate please contact our office toll free at 800-347-1074 or 515-270-6169. 
 
Please also note: All information will be kept on file to use until otherwise notified by you.  Please feel free to update information as it changes.