THE POWER OF HERSTORY –

TERMS & CONDITIONS

Story Submissions

Share Your Story

Thank you for your courage in sharing your story. Please read and agree to the terms and conditions before submitting your story. We receive many submissions and are not able to publish them all, but greatly appreciate your strength in completing this form to share your story.

THE POWER OF HER STORY - Terms & Conditions

“THE POWER OF HERSTORY” Terms and Conditions As a survivor we invite you to tell us your story to…strengthen, empower, encourage, and support others! Including real life experiences of survivors is crucial to our work to end domestic violence and abuse at the local and state level. Hearing directly from survivors about their experiences and the impact of domestic violence on their lives can inspire and empower others to act, as well as help reduce or remove barriers faced by survivors and their children. Survivors sharing their story can connect them in important ways and provide opportunities for survivors to share their stories as well. Please read and agree to the terms and conditions before submitting your story. We receive many submissions, unfortunately, we may not be able to publish them all. However, your courage is greatly appreciated by completing this form to share your story. Thank you!

Checkboxes

I am at least 18 years of age and am acting in my capacity as a legal adult in signing and agreeing to the Terms and Conditions of this form submission.

I am a less than 18 years of age, and as a minor have the permission of a parent or legal guardian to sign and agree to the terms and conditions of this form submission.

First Name

Last Name

Address

City

State

Zip Code

Phone

Confirmation Email

This information is collected so that we are able to report out this data for various grants in aggregate as we are legally required or requested to do so. This information will not be shared as part of your story.

My Sexual Identity:

Straight/Heterosexual

Gay/Lesbian

BiSexual

I'd rather not say

My age is:

My Story (500 words or less):

Would you be interested in Virtually sharing your story during a PLF Event

Yes

Would you like to be a PLF Volunteer?

Yes

Which types of opportunities would you be interested in at this time? (Please check all that apply. You can opt in or out at any time.)

Writing and providing a short, written quote about how my experience with PLF helped me

Contributing artwork (including, expressive artwork such as poetry, creative writing, collages, pictures etc.) that can be used to help PLF’s initiatives

Having my photo used in marketing materials for PLF (including, website, social media, emails, newsletters, annual report, appeals to donors, etc.)

Being interviewed for PLF’s publication purposes

Participating in a video interview about how my life experiences and/or work with PLF

Being interviewed by the media for news related purposes (anonymity optional)

Speaking at a PLF staff meeting, board meeting, community awareness events, outreach events, volunteer trainings, conferences, support groups and/or other related venues

Other

• Terms and Conditions for Submission I hereby irrevocably agree and consent that the Pneuma Life Foundation, or “PLF,” may use all or part of my submissions with this form “The Power of Herstory” as a contribution and donation to the Foundation for any purpose of their choosing. I shall not now—nor at any future time—be entitled to, nor shall I make claim to 1) any wages, royalties, or compensation of any kind for my “The Power of Herstory” submission as used by PLF/or, 2) ownership or executive interests in my “The Power of Herstory” submission as I am donating ownership and all rights to PLF. The rights granted herein to PLF are perpetual, worldwide, and include the use of my submission in any print, sound, digital or electronic medium available now or that may become available in the future. I am voluntarily choosing to give all ownership rights to my submission to PLF. Pneuma Life Foundation is not obliged to make any use of my submission or exercise any of the rights granted to them by this release. All rights granted herein, by me to PLF, as well as all terms of this agreement and consent, shall insure to the benefit of the successors and assigns of PLF. I understand that my submission will not be posted if it is not appropriate in the opinion of Pneuma Life Foundation’s general audience. I understand that my submission may be altered if it contains names of specific individuals or places. I understand that my submission will not be posted if it contains any information that is potentially harmful or against any laws, policies or ordinance with which PLF must comply. I agree to hold PLF harmless for any consequences I may incur for submitting my story. Please read the terms and conditions above and respond below: *

I hereby agree to the terms of this Submission, Release and Hold Harmless Agreement.

I do not agree to the terms of this Submission, Release and Hold Harmless Agreement.

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