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Tell Your Story

Tell Your Story of MS!

Everyone who walks, rides, runs, skis, or volunteers for the National MS Society has a story to tell about their connection to MS.

WHY IS YOUR STORY NEWS?

When you tell your story of MS through the news media it:

  • Creates awareness of the disease, 
  • Increases recognition of the Central New England Chapter, 
  • Builds understanding of Chapter programs and resources, and
  • Promotes giving opportunities to support our mission.

WHAT IF I'M NOT A WRITER?
It's easy to answer the questions on this form, remember three simple rules:

  1. Write like you talk.
  2. Don't think...just write!
  3. Everything is important.

YOUR PRIVACY IS IMPORTANT TO US.

Story opportunities in the local news media will be pursued based on your answers to the questions on this form.  If you feel that certain information is important for the Chapter to know, but that it should not be made public, please make that clear in your written answers, and your wishes will be respected.

 

Contact Information
  Please provide your contact information:

If you have previously registered, please login here to prepopulate your information.

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Name:

 

 
   

 

 

 

City/State/ZIP:

 

    

 

 

 

 

 
Date of Birth:



 

 What's this?

   


   


   


 

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Question - Not Required - What is your connection to MS? Please note: The National MS Society respects the privacy of people who have multiple sclerosis, and only discloses names if individuals give express permission.

 


 

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If you have MS, please answer the following questions. (If you don't have MS, you can skip ahead to the Event Participants section.)

 
 

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What has been the impact on you and your family ...
 

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Question - Not Required - If so, which one?






 

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Event Participants

Which Chapter events are you involved with?
   


 
Question - Not Required - Bike MS rides:

 


 


   


 

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Question - Not Required - What type of team?


   


   


   


 

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Media Release

By submitting this form I confirm that I, in consideration of good and valuable consideration, including my desire to benefit the National Multiple Sclerosis Society, receipt and sufficiency of which is herein acknowledge as received, hereby grant to the National Multiple Sclerosis Society, its Chapters and affiliates ("NMSS"), and its successors, legal representatives and assigns, and those acting with its authority and permission, the irrevocable and unrestricted right and permission to use, reuse, reproduce, display, and create derivative works from personal home videos and family photographs that I have supplied to NMSS, and to use and reuse any likeness of me or likeness in which I may be included, in whole or in part, or composite or distorted in character or form, without restrictions as to changes or alterations, in conjunction with my own or a fictitious name, and for any purpose whatsoever in any and all media now or hereafter known, including video or other audio format, and including the NMSS web site.

I also consent to the use of any printed matter in conjunction with the above.

I hereby waive any right that I may have to inspect or approve the finished product or products or other matter that may be used in connection therewith or the use to which it may be applied.

I hereby release, discharge and agree to save harmless NMSS, its successors, legal representatives and assigns, and all persons acting under its permission or authority or whether intentional or otherwise, that may occur, or in any subsequent processing thereof, as well as any screening thereof, including without limitation any claims for libel or invasion of privacy.

I hereby warrant that I am of full age and have the right to contract in my own name.  I have read the above authorization, release, and agreement, prior to its execution, and am fully familiar with the contents thereof.  This release shall be binding upon me and my heirs, legal representatives, and assigns.

 
   


 
Question - Not Required - Date:




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