Share Your Journey

First Name *

Last Name *

Email *

Address *

City *

State/Province *

Zip/Postal Code *

Country *

Media Release - If your story is selected, do you agree to the following? *
I grant to The Hypersomnia Foundation, the right to use, reproduce, and/or publish photographs and/or video and/or writings that may pertain to me—including my personal journey written story, image, likeness and/or voice without compensation in connection with the Sharing My Journey response. I authorize The Hypersomnia Foundation to copyright, use and publish the same in print and/or electronically. Please note that The Hypersomnia Foundation retains the right to edit all submissions, including personal journey submissions. I agree that The Hypersomnia Foundation may use such writings, photographs and/or video of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, SomnusNooze, and Web Page content. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, The Hypersomnia Foundation may publish materials, use my initials and city/state and/or country of my location, photograph and/or video, and/or make reference to me in any manner that The Hypersomnia Foundation deems appropriate.
  I Agree

Which of the following personal information will you allow the Hypersomnia Foundation to share with your story? *Select one...First and Last Name, City, State/Province, CountryFirst and Last Initials, City, State/Province, CountryAnonymous, City, State/Province, Country

File Upload *
If you prefer to write your story in a document, you may upload your document here. Accepted file types include .doc, .docx, .pages, and .txt. Max file size 5MB.

Your Journey *
In 500 words or less, please share your personal story in the box below. Or, write your story in a document and upload it above.

Photo Upload *
If you have a photo of yourself that you would like us to share with your story, please upload it here. Please make sure that you own all the rights to any image before uploading. Max file size is 5MB.

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