Story Submissions Form

Hero Photo/Journey/Video Submissions
Hero's Name*

First NameLast Name - Will Not Be Published
Parent's Name (type N/A if hero is an adult)*

First NameLast Name
Cleft Type*
State/Country Hero Lives In*
Parent/Adult Hero's Phone Number*
Parent/Adult Hero's Email Address*
I am submitting: (select all that apply)*

Awareness videoPhoto(s) for LCN awareness and marketingPhotos (1-3) for hero's birthday social media postJourney page photos (no more than 10)Written journeyVideo journey
Hero's birthday (if you'd like a happy birthday post on social media):
Upload Photo(s)

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Upload Written Journey

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Upload Video

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Standard Terms and Conditions

In these Standard Terms and Conditions, “Your Content” shall mean any audio, video, text, images, or other material you provide or display. By providing Your Content, you grant LCN a license to read, use, reproduce, adapt, modify, publish, translate, and distribute it in our marketing materials and to all media. Your Content must be your own and must not invade any third‐party’s rights. When you submit content or information to LCN it means that you are allowing the public to access and use that information, and to associate it with you. LCN reserves the right to remove Your Content at any time, without notice. We take your privacy very seriously. Subject to the Terms and Conditions above, LCN will never sell or disclose your personal information.
Consent*

I agree to the Terms and Conditions above.
Age of Consent*

I am a parent representing my minor child.I am an adult representing myself.
Should be Empty:

Hero Photo/Journey/Video Submissions