Share Your Story

Share Your Story - Western States Region

(Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, Oregon Utah, Washington)

Our survivor volunteers are the heartbeat of everything we do.
Your story has the power to raise awareness, inspire others, and help fellow survivors feel seen and supported. Your voice brings our mission to life.

We’re honored you’re considering sharing your story with us. Thank you for being part of this movement. We can’t wait to meet you.

Choose Your Location (required)*

Full Name: (required)*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail (required)*

Phone Number (required)*

Preferred Method of Contact (required)

Preferred Method of Contact*

Age (required)*

If you are submitting a story for Kids With Heart, please list the age of the child.

Legal Guardian Full Name:*

First NameLast Name

Gender (required)*

Were you or your loved one saved because of CPR? (required)

YesNo

Have you or your loved one suffered from heart disease or stroke as a result of smoking? (required)

YesNo

Would you be interested in sharing your personal story as a spokesperson for the AHA? (required)

YesNo

Select the option that best identifies your story: (required)

HeartStrokeLifestyle ChangeOther

Date of incident (required)

MonthDayYear

Location of cardiac or stroke incident (required)*

Do you need some help sharing your story? Here are a few tips to get you started:

1. Tell us about you

Share your name (and nickname if you have one)
Tell us about your family (parents, children, siblings, pets)

2. Tell us about your heart.

3. How is your heart different than others’?

4. What happened?

If it’s a heart condition, which one is it?
How old were you?
What did the doctors do to make you better?
How did this make you feel?
How did this experience change your life? Are there things you can’t do anymore?
How did this affect your friends and your family?

5. Tell us about you now

Are you better? How do you feel now?
Do you have any habits that help keep your heart healthy so it doesn’t get sick again such as taking medicine, eating healthier or getting physical activity?
What do you like to do? Any favorite hobbies or activities?

6. What is your wish for other's with heart disease? Or, for our child survivors, what do you wish for other children with sick hearts?

7. What do you want people to know about the American Heart Association? Or about participating in Jump Rope For Heart, Hoops For Heart, Heart Walk or other events?

Please know, the American Heart Association (AHA) is grateful to people like you for sharing your story. Your stories are why we continue to work hard each day to find cures, treatments and change public policy and behaviors.

For our child surivors, kids love hearing about other kids, especially when they use their own words to tell their story from a kid’s perspective. Please know that the story does not have to be long, as kids appreciate ‘short stories’.

This can be your starting point, an AHA representative will contact you to find out more.

Please share your story in 1,000 words or less. (This field is required, but it may help to write your story in a Word document and attach the document below.)*

0/1000

Attach Word document

Please attach 1-4 high resolution photos of yourself":*

Acceptance of Terms:

I have read and accept terms of this Authorization and release the American Heart Association, its affiliates, directors, officers, employees, agents, volunteers and representatives ("AHA").

Accept

If Under 18 - Legal Guardian Acceptance of Terms:

I have read and accept the the terms of this Authorization and release the American Heart Association, its affiliates, directors, officers, employees, agents, volunteers and representatives ("AHA").

Accept

Please disregard the fields in the Authorization and Release document that require you to fill out information and provide your electronic signature below to acknowledge that you have read the document and you understand and agree.*

* If under 18 Legal Guardians must sign as well.

Guardian signiture*

To keep your medical information secure, please hit submit and you will receive an email address for your local Communications Director. You can email them your story or wait for them to reach out to you.

NOTE: Moving forward this form is used as an initial conversation with CDs and we'll have them fill out our release afterwards

Thank you so much for sharing your story!

Questions? Please email us.

Address (required)

Address 2

City (required)

State (required)

Zip Code (required)

Age (required)

Ethnicity (required)