Tales From The Heart Form

1
Name
First Name
Last Name
2
E-mail
3
What is the title of your book?
4
What is the link that individuals can purchase your book?Please also note if your book is available in any other languages.
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5
Please include a photo of you with your book or a photo of your book cover that we can share on our social media platforms
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Select files to upload
Max. file size: 10.6MB
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6
Video upload of your pre-recorded storytimePlease make sure that you film "landscape" (horizontally) if filming on a mobile device.
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Select files to upload
Max. file size: 10.6MB
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7
Consent* This field is required.I hereby grant CHD Tablet Talk, royalty-free, non-exclusive, perpetual (for the duration of the applicable copyright) license to reproduce the photograph(s), audio or video media, and to incorporate the media into one or more Collective Works (including but not limited to newsletters, websites, and any other media or publications as CHD Tablet Talk deems appropriate for promoting program activities, and to reproduce the media as incorporated in the Collective Works. The above rights may be exercised in all media and formats whether now known or hereafter devised. The above rights include the right to make such modifications, including but not limited to cropping or altering the photograph(s) as are technically necessary to exercise the rights in other media and formats.
I consent to the above agreement
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