WHY SHARE YOUR PHOTO & STORY:

The Global Tracheostomy Collaborative is seeking patients and families who are willing to share their photo and tracheostomy story with the GTC for the purpose of helping to educate the global community and promote awareness about life with a tracheostomy. Your photos and stories are vitally important and powerful. You can actively participate in the Global Tracheostomy Collaborative’s mission to improve the quality of care for patients with tracheostomies around the world by sharing your story and promoting awareness.

SUGGESTIONS FOR SHARING YOUR PHOTO:

• Photos may be of the individual with the tracheostomy alone, or along with additional family members.
• It is helpful if the tracheostomy is easily identifiable in the photo for awareness purposes
• High quality images are best for use on the website and print
• We are aiming to show our tracheostomy community members in their everyday life, so photos highlighting life events, activities, hobbies, and/or celebrations are wonderful.

SUGGESTIONS FOR SHARING YOUR STORY:

Our goal is to highlight as many patient and family stories from around the world as possible. Therefore, we are requesting that stories follow these guidelines:

Paragraph 1: “You (patient) or your child/family member”

• Share a bit about you as a tracheostomy patient, or the individual in your family with the tracheostomy
• Include a general summary about age received tracheotomy, reason, purpose, short-term or long-term need, and/or personal experience, etc.

Paragraph 2: “Tracheostomy care & the GTC” Share a comment or reflection about one of the following:

• Share something that went really well in your experience with getting and caring for a tracheostomy, something you would want to be included in everyone’s care experience
• Highlight a situation or challenge in your care experience with a tracheostomy, something that you would hope that the GTC may be able to help address as we promote quality improvement efforts
• Comment or provide a quote about what it means to you to have a quality improvement collaborative developed for the tracheostomy community.

Thank you for considering supporting the Global Tracheostomy Collaborative by sharing your photos and stories. You can submit your stories using this form or emailing admin@globaltrach.org.   

You must sign the consent form below in order for GTC to publish your photos or story. 

By signing this form, I hereby authorize the Global Tracheostomy Collaborate (GTC) to use, modify and disclose images of me and/or my personal story for the purposes described in this form. The term “Images” includes photographs, movies, videotapes, audio tapes, as well as any copies, prints, negatives, computer graphics or electronic images from any of the above. As applicable, I also authorize the GTC to interview me or to share my story for the purposes described in this form. The permitted uses and disclosures of my Images and related information (as applicable) include:

• Articles in GTC publications (online and/or print)
• Fundraising, publicity, promotions, marketing or advertising activities of GTC
• Posting on GTC Web sites (internal Intranet and/or external Internet) or any GTC sponsored use of social media
• Articles released to the print and broadcast media (e.g. radio, television, newspapers, magazines), external websites and all types of electronic communication media and social media

I further consent to my Images being placed in a central repository of similar materials within GTC for future use, unless I indicate otherwise. I understand that I may be identified in any use or disclosure of my Images. I hereby waive the right to receive a copy, inspect or approve the Images or related information for the purposes described above, and also waive any and all rights that I may have to any claims for payment or royalties in connection with the above use of Images or related information. I understand that GTC and its corporate affiliates cannot control how third parties may use my Images and/or related information. I release GTC, its affiliated entities, their directors, officers, employees and agents from any and all claims, actions, damages, and liability of any kind arising from any of the permitted uses and disclosures described in this form. I acknowledge that the Images are and will remain the sole property of GTC.

I understand I have the right to refuse to sign this Authorization and that this Authorization is valid unless I cancel or revoke it in writing. If I choose to revoke this Authorization at any time in the future, I will send my revocation to admin@globalaltrach.org. My written revocation will not affect any disclosure of Images or Information made before the receipt of my revocation by GTC.

Use the link below to upload your Photo(s):

Upload your images and videos here

 You may also email your photos to admin@globaltrach.org

By Signing this form, I acknowledge that I completely understand all the undertaking.