Prevention Stories Submission

Name*
First Last
Email*
If applicable, please tells us your coalition name.
Your Prevention Story.*
Please submit your story here. (Limit of 500 words)
Acknowledgement and Assignment
I am submitting a prevention story entry with this form, and I hereby assign any and all rights in the intellectual property of this entry to ACT Missouri. I agree that the entry I submit becomes your property and that the entry will not be returned to me. I state that this entry is my own original creation and that I did not copy anyone else's work in creating this prevention story. I authorize the use by you, without compensation, of my name and my prevention story for promotional purposes in any manner and in any medium (including without limitation the Internet, written or email communications, brochures, videos, slides, radio, television, film) that you deem appropriate.
Signature*