Oncology On Canvas Splash Page

To ensure the best possible experience, please use your desktop or laptop computer to submit art.

The Oncology on Canvas^® Program at Lilly

Online Submission Form

Type your information into this three-step submission form. Remember that you can’t save your submission form and come back to finish it later. So before you start, be sure you have a digital copy of your art, the submission’s title, and a narrative that describes the art and what it means to you.

Tell us about the art you’re submitting
Tell us about yourself
Digitally sign and submit the form, and upload your art or poetry

Please select your art category:

Entry Title:

Entry Narrative:

Poem: (Enter the complete text of your poem in the area below.) Song Lyrics: (Complete lyrics are required for music that includes words. If your music is instrumental, please enter “Not Applicable” in the area below.)

Please upload a high-resolution JPG or PNG version of your artwork.

Please do not include personal identifying information, such as full names or address; drug names; or names of specific healthcare facilities or healthcare providers in your submission. For more information, please review the Official Submission Program Terms.

You also may submit a visual copy of your poem. (This is optional.)

Which of the following best describes you and your entry? I am a:

Please select your Title (optional):

Please select Professional Designation (optional):

First Name:

Last Name:

Email:

Confirm Email:

State:

ZIP:

The personal information provided in this form - including your name and email - will only be viewed by the LOOC program administrators and/or agents as needed for the purpose of administering this program. The LOOC program administrators and/or agents are privacy-trained and will record your information on a password-protected basis.

LOOC program administrators may contact you if more information is needed regarding your submission, and/or if Lilly would like to use the artwork and narratives for a different purpose than what is stated in the Official Submission Program Terms.

For more information about Lilly’s privacy practice, please view the Privacy Statement.

I confirm that I am a resident of the United States or Puerto Rico.

I am submitting on behalf of a minor.

By checking this Consent and Release box, I consent to allow the above named minor to participate in the Lilly Oncology on Canvas program and for the personal information about the above named minor to be used and shared as described in this form and the Official Submission Program Terms. I represent and warrant that (i) I am eighteen (18) years of age or older and I am legally competent to execute this Consent and Release Form under the laws of my country, (ii) I have the legal authority to represent the above named minor, and (iii) I have read and understand this Consent and Release Form and the Official Submission Program Terms and (iv) voluntarily sign this Consent and Release Form on behalf of the above named minor.

I am interested in telling my personal cancer story, possibly to the media or other interested parties. You may contact me to discuss this further.

I am interested in receiving Oncology on Canvas program updates from Lilly via email.

How did you hear about Lilly Oncology on Canvas?

Please read the following statements and indicate your acceptance of them by selecting the box below and submitting this submission form.

I am at least 18 years of age and submitting original artwork: 1) on my own behalf; 2) on behalf of a minor of whom I am the parent or legal guardian; or 3) on behalf of an adult family member/friend from whom I have obtained written legal consent.
I hereby acknowledge that I have read, understand, and agree to be bound by the Official Submission Program Terms of the Oncology on Canvas Art Program at Lilly on behalf of myself (and the participant I am submitting on behalf of, if applicable).
I understand that by submitting this visual artwork, narrative, poetry, and/or other materials (collectively referred to as the “Submitted Artwork”) to the Lilly Oncology on Canvas program to be considered for inclusion in this Program, I am transferring to the Oncology on Canvas program at Lilly, full ownership rights, including but not limited to all copyright and other intellectual property rights, I have to the Submitted Artwork, including but not limited to the right to use, reproduce, modify, display, or publish all or any portion of the Submitted Artwork in: any medium (e.g., online, print, television, mobile application, social media, electronic displays at medical or advocacy meetings, or any other public forum, etc.); collateral materials (including but not limited to media materials, brochures, educational books, postcards, websites, social media, etc.); exhibits; and/or any other manner as determined by the Oncology on Canvas program administrators, as well as the right to sublicense and transfer to others any of these rights. I also waive any attribution, integrity, or moral rights in the Submitted Artwork related to any use of the rights I am transferring under these Terms and Conditions. This assignment of rights is effective at submission and is binding upon my successors, heirs, and assigns.
If I am interested in any public display or performance of the Submitted Artwork, I will contact the Oncology on Canvas at Lilly program administrators for prior approval.
I understand that, if the Oncology on Canvas program administrators transfer ownership of the Submitted Artwork to others, it may be to organizations such as nonprofit cancer-related advocacy groups or charitable organizations for use in their fundraising efforts or for other appropriate purposes, without any payment to me or any financial benefit to Lilly.
I understand that any Submitted Artwork may be incorporated into a traveling exhibition, touring various locations such as cancer centers, hospitals, and patient advocacy groups. Submitted Artwork may also be displayed at media events, televised, and/or showcased on the Internet, in print, and via other types of media designated by the Oncology on Canvas program administrators. Also, some of the Submitted Artwork may be featured on the Lilly Oncology on Canvas website (https://www.looc.lillyoncology.com) and/or in educational resources about the cancer experience. Additionally, some of the Submitted Artwork may be featured in educational materials and/or exhibits outside of the United States and Puerto Rico.
I understand that the Submitted Artwork, participant category, cancer type, artwork title, narrative, and artist’s state or territory may be made public as stated in the Official Submission Program Terms.
I understand that the Submitted Artwork will not be returned to me, neither as an original or a copy.
I understand that LOOC program administrators cannot guarantee that any specific Submitted Artwork will be included in any media event, book or other printed material, website, etc; nor can they guarantee that the Submitted Artwork will be featured in an exhibition.
I understand that the information I am providing may be used by Lilly USA, LLC (Lilly), and its business partners for the purpose of administering the LOOC Art Program. By submitting this form, I indicate my consent to this use. I understand that I may request to be removed from your contact list by calling The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979) or writing to Lilly at the following address: Lilly USA, LLC, P.O. Box 6245, Indianapolis, IN 46206-6245.
If the Submitted Artwork shows the likeness of any person(s), I warrant that any such person(s) has given permission for this creative work to be submitted. If this Submitted Artwork is a photograph or any other recognizable likeness of a person who is under the age of 18, I warrant that I have written permission from the person’s parent or guardian for this creative work to be submitted and used as described in the Official Submission Program Terms. Further information is under the “Use of Personal Information” section in the Official Submission Program Terms.
By submitting an artwork that is incorporating recognizable or abstract facial images, I understand these images will not be treated as confidential or private information, since they may be displayed publicly and will be transferred through systems such as the US Postal Service where the sponsor cannot control the confidentiality of the work.
I understand that, if I am a government official/employee, or an individual employed by or affiliated with an organization, there may be policies against participation in industry-sponsored activities such as the Oncology on Canvas program at Lilly. It is my responsibility to ensure that I am permitted to participate in this Program before submitting creative works.
As a participant, I may be offered the opportunity to participate in media interviews concerning the Program. I understand that I can either accept or decline these opportunities.
I understand that the LOOC program administrators and/or agents may contact me for more information about this submission.They may also contact me if they would like to use the submission for a different purpose than what is stated in the Official Submission Program Terms.

I hereby submit my artwork and narrative to Lilly Oncology on Canvas and agree to abide by the Official Submission Program Terms.

The Oncology on Canvas® Program at Lilly

The Oncology on Canvas^® Program at Lilly