Share Your Story

• I am 18 or older.
• I am under 18. A parent or guardian also signs below.

Check everything that applies.

• A story I write myself
• An interview that Keepers of Khora writes up with me
• Video of me
• Audio recording of me
• Photos of me
• A short quote

Check each place you are comfortable with. We will only use your story in the places you check.

• Khora Talks on keepersofkhora.com
• Keepers of Khora social media Instagram @keepers.of.khora and Facebook
• Our email newsletter
• Events and presentations Slideshows, talks, printed flyers
• Grant applications and reports to funders
• Fundraising and donation appeals

We will never sell your story or give it to another company to use in its advertising.

Your name

• My full name
• First name only
• First name and last initial
• No name. Share it anonymously.

Your face and voice

• Show my face and use my voice
• Don't show my face We can film hands, the room, or the back of your head, or blur your face.
• Voice only, no images
• Not applicable, written story only

Anything we should not mention or show, such as your city, workplace, school, family members' names, diagnoses, or dates.

• Send me the final version first. Recommended. Nothing goes live until you tell us it is okay.
• I don't need to review it.

We may shorten your story or fix spelling and grammar. We will not change its meaning or put words in your mouth.

Please don't name or show other people without their permission. Anyone who can be recognized in your video or photos needs to fill out their own form, or we will blur or remove them.

You can take back your permission at any time by emailing Keepersofkhora@gmail.com, with no reason needed. Within 7 days we will remove your story from keepersofkhora.com and our own social media accounts and stop using it in anything new. We cannot take back things already printed or sent, or copies other people saved or reshared.

• Sharing is your choice, and it is unpaid.
• Saying no, or changing your mind later, will not affect your place at our events or any support from Keepers of Khora.
• We keep this form and your contact details private and use them only to manage your story.
• Khora Talks is a space for community stories. It is not therapy or medical advice.

I give Keepers of Khora permission to use my story, and any photos, video or audio I provide, in the places I checked above, without payment. I keep ownership of my story and can share it anywhere else I choose. This permission lasts until I take it back in writing (email is fine). The story is mine to share and true to the best of my knowledge.

• I have read this form and I agree. *