Share Your Story With Us

Share Your Story with Us

Please fill out this form to share your story/journey with us. We are constantly looking for new stories to tell that will connect our community together, inspire others to keep moving forward, and make your voices heard.
Full Name*

First NameLast Name
Email*
example@example.com; This information is for Association use only.
Phone Number*
Please enter a valid phone number. This information is for Association use only.
You will be contacted by a member of our Marketing & Communications Team after submitting this form. You may be asked follow-up questions.
What city/state are you located?*

Street Address

CityState

Postal / Zip Code
Please select how you would like to be identified in your story.*

I give permission to use my first name, last name, and city/state.I would prefer to remain anonymous - you will be listed as "First Name, City/State" (Example: Sally, Washington, D.C.)
What is your relation to ALS?*
Would you be comfortable being filmed for a video regarding your ALS journey, if the opportunity presented itself?*

YesNo

What would you tell someone who is thinking of donating to or volunteering with The ALS Association?
Please upload a photo of yourself.

This can be a photo that represents your ALS story.
Cancelof
Acknowledgment

By submitting this form, you are giving The ALS Association exclusive permission to use your story in any form of media (social media, news story, email, etc.).

If you indicated that you prefer to remain anonymous, no identifying details will be used publicly.

*We will not for any reason release your email or phone number.
Should be Empty:

Share Your Story with Us