Stories of Loss- Submit

How to Submit Your Story
To have your story included as a part of Miscarriage Matters Inc. book and blog, please follow these instructions:

1. Complete form below.

2. Write down the story of your pregnancy and loss. You can make it as short or as long as you would like, as simple or as detailed as you feel comfortable with. Your story may be slightly edited for grammar/spelling, spacing and format. We may also edit profanity, at our discretion.

3. At the beginning or end of your story, please include the following information:

Your first name, your lost child/children’s name(s), and their date(s) of birth and death

Your city/state

Your email address.

The categories that are available for your particular stories will be miscarriage, stillbirths, or early infant loss. Please tell us which type of loss your story reflects.

*Tell us how you found out about us! Facebook, Twitter, LinkedIn, Pinterest, Instagram, or search engines.

3. Include a photo of your face. Please make sure the file is at least 2×3 inches and in JPG format. We will be adding text to the bottom that says, “I am the survivor of ______.” Please let us know what you would like in the blank for example: “I am the survivor of miscarriage,” or “I am the survivor of stillbirth.” Note: Please make sure the photo only includes the author of the story . While we realize that there is a father behind every story, we really want to keep the photos to single faces. If the father would like to add his own story and photo that would be wonderful and we would encourage and welcome them to share their own story from a fathers perspective.

(Please do not include any pictures unless it is a head shot. We are unable to use photos of babies, family, pets, material items.)

4. Deadline for story submissions - September 1, 2018 (Must be submitted by this date to guarantee your story will be published in our 2018 book.)

Authorization and Story Submission Form

This form gives authorization to Miscarriage Matters, Inc. to use my photo, story, and all contents that I am voluntarily providing for full use as the organization sees fit. I am aware that my information submitted will be in a book compiled of many other stories, and I wish for my information (photo and story of loss) to be included. I realize that by giving my information and submitting my photo, I freely grant full, total, and complete permission to Miscarriage Matters, Inc. to use/own my information and will not seek claim to proceeds generated in anyway. I release Miscarriage Matters, Inc. of any and all liability. I simply want my story to be included in their book. *

I agree I don't agree

* Indicates required field

Name *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

I am a Survivor of... *

I will submit a picture for the book *

Yes, It's attached below No, I don't want my picture published in the book

Upload File *

Max file size: 20MB

My Story is... *

Below in the comments Sorry, I changed my mind. I don't want to submit my story

Comment *

Submit

How to submit your story

Authorization and Story Submission Form