The Keep Smiling Movement DOSE of HOPE Chapter

We are looking forward to reading and sharing your story as your story will help save lives, bring smiles to others' faces, and help others find resiliency in their own situations.

Please note the word count is between 1500 and 3000 words total.

Please be sure to answer the questions so that the questions are within your answers as the questions will not be printed in the book.

The answers should flow so that when put together they flow as if they are an entire story.

I suggest you write your answers into a word document, then copy and paste your answers into the form.

In following these directions, you have a backup should there be a glitch in the technology.

Your submission means you grant us permission to edit, print, and publish it.

Full Name as you wanted printed and published as the author of your chapter:*

First NameLast Name

Email*

example@example.com

Cell Phone Number*

Please enter a valid phone number.

Come up with your own Chapter Title:*

Who is this dedication addressed to:*

WHO- Who are you from birth to now? (This is where you write your Journey from childhood to now, include the challenges and obstacles that took away your smile, how you overcame to get your smile back, and what this process taught your regarding resiliency?):*

WHY- What is your Deepest Why? Why you do what you do? Why it excites you? Your why ... is as if you are describing Your Calling or Purpose Driven Life.*

HOW – How you are, as in How you create abundance, solve problems, and inspire smiles. Your proof you are effective.*

Book(s) That Changed Your Life*

Movie That Inspires You*

Your hero*

Quote You Live By:*

Also, Send your Short Bio (the one you would use to be introduced on the radio ortelevision (100 to 150 words))*

From where or whom did you hear about this project? Enter the referral person's full name if you know it including Dr. Ken Rochon and Dr. Andrea Adams-Miller's names.

Where do you live? (City & State) and (Biggest City Near You)

What city/state and at what event - with what host -- do you recall getting your Keep Smiling photo taken?

What is your title of what you do? ie. Speaker, Author, Artist, Financial Advisor, Healer, Business Consultant, etc.

For legal reasons, please make all donations to PayPal @KeepSmilingMovement or to PayPal keepsmilingmovement@gmail.com, or text Dr. Andrea Adams-Miller at 419-722-6931 for wire instructions or to ask for other donation options, ie. real estate, airline points, products or services, or auction items. The Keep Smiling Movement is a mental and dental health organization, 501(c)3, Federal ID #47-2092152. Questions? Text 419-722-6931 Dr. Andrea

Leave A Legacy:

Thankyou!