Diane's Cancer Site Award

DIANE'S STORY OF LIVING LIFE WITH BREAST CANCER
AND DYING WITH DIGNITY

Apply for "Diane's Excellent Site Award"

"Diane's Breast Cancer Award of Excellence" SAMPLE

If you have a Cancer related site and would like to apply for Diane's Award please complete the simple on-line form below.

We would enjoy hearing from you and visiting your site on behave of Diane.

The award image is 30.2 KB and is in JPEG format.

Please note: we do not give awards to any site that links to or contains adult content.

We will visit your Site and if appropriate we'll inform you via e-mail if you have won "Diane's Excellence Site Award" and forward Diane's award to you as an attachment.

If you win the award a link back to "Diane’s Story of Living Life with Breast Cancer And Dying with Dignity" at http://diane.ponpines.com/ via the graphic would be nice but it is not a requirement to receive her award. Diane would have wanted it no other way!

Diane's Site does not rent, sell, or share any personal information about
you with other people or companies.

Please direct any problems or questions about Diane's Site to her brother Lyn at the address below
webmaster@ponpines.com

PERSONAL INFORMATION: (Items with a * are optional)

Today's Date (mm/dd/yy):

Your E-mail Address:

* First name Last initial:

* State or Location:

* Outside U.S.:

URL INFORMATION:

URL of your site:

Brief Description of your site:

ADDITIONAL COMMENTS:

* Please use the space provided
for any additional comments
you might have:

Thank You for your time and
our very Best Wishes to you!