Please Fill Out The Below Form To Share Your Story

"What's Your Story?" Campaign 

By submitting your information and story, you give the NPH Foundation expressed permission to publish your story, and or record and use your interview, in video, print, or other digital media, including your voice, image, likeness, and statements. 

The NPH Foundation to use, edit, reproduce, publish, and distribute my recorded or written content, in whole or in part, for purposes including, but not limited to: 

• Educational materials 
• Public awareness campaigns 
• Marketing and promotional materials 
• Social media and website content 

I understand that: 

• My participation is voluntary. 
• I will not receive compensation for the use of my story or likeness. 
• My interview and or story may be edited for length or clarity while maintaining the intent of my story. 
• Once content has been published, it may not be possible to remove it from all platforms. 
• I may request to remain anonymous. If this request is made, your story may be shared anonymously without reference to any specific name (names may be changed to protect anonymity) and/or identifiable characteristics. 

I confirm that I am at least 18 years of age and voluntarily grant the NPH Foundation permission to use my recorded and and/ or submitted content as described above.