Form
Where do you reside (City, State: Ex, Columbus, OH)
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What is your current age?
Are you sharing your own experience or someone else’s? (Multiple choice: My own / A family member’s / A friend’s / Other)
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My Own Story
A Family member
Friend
Other
Please share your story. If applicable, what substance(s) were involved?
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Did you or your loved one seek treatment or recovery resources? If so, what was the experience like?
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How has this experience impacted your life or perspective?
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What do you wish more people understood about addiction and overdose?
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If you lost someone to overdose or addiction, what do you wish people knew about them?
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Do you have a message of hope or awareness or advice you’d like to share?
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Have you been involved in advocacy, harm reduction, or recovery efforts? If so, please share.
Do you give permission for your story to be shared anonymously at our event?
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Yes
No
Would you like your story to be considered for future advocacy projects?
Yes
No
How did you hear about this submission opportunity?
Social Media
Friend
Community Organization
Other
Is there anything else you’d like to share?
Submit
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