Share Your Story Submission Form

Name *

Phone *

Email *

Best Contact Method:

Phone
Email

Topic *

Your Story *

Do you have photos or a video to share? (you can send them to us later) *

MEDIA RELEASE

I give permission to Disability Network Northern Michigan (DNNM) to photograph me and/or to use audio and/or video equipment to record my participation in DNNM, events, programs, etc. I understand that printed materials and/or visual/audio media (such as brochures, websites, reports) may be used to distribute information that supports the mission of DNNM. *

Check the Box *