Your Full Name
Thank you for sharing your story!
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I would like to share my memoir or testimonial with Hospicare to help spread the word about their services.
Please contact me for an interview
I would be interested in a photo shoot
I'd love to tell my story via video
I will include my written story below
By choosing YES below, I hereby authorize Hospicare &Palliative Care Services to use my name, any images I provide, or likeness (such as picture, video image or photograph) or quotation of my remarks for public information, fundraising purposes, education and outreach efforts including news media and social media (such as Facebook or YouTube) and similar purposes. I understand that these activities may involve the creation of materials to be distributed, displayed, or sold to the general public.
Fill out the information below to share your story here.
Upload photos should be minimum 800x800px
If you have any questions or have another story to share, please email Sara Worden at firstname.lastname@example.org.
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