Story Book Instructions

Check list for those who wish to record their stories on

Friday Evening, July 8, 2011 during the Reception:

  1. Print a copy of
  2. Read the Release Form and sign and date it if your agree.
  3. If you do not agree to the terms and conditions  of the form, terminate your use of this page.
  4. If you agreed, continue on and fill out the form on this page completely and SUBMIT it. This notifies us
    We will assign a time slot to you based on the time stamp when we receive your submission.
    Note: you must bring a signed paper copy of the Release Form  and a filled out copy of your Story Book Questions with you on Friday evening before being allowed to tell your story.
  5. Please fill out and SUBMIT the form below to receive a time slot.
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Story Book Registration Form

All Fields are required unless marked as optional

Please do not use the following punctuation in fields quotation marks, apostrophies, commas or periods

Make sure each required field has valid information

Persons under 16 will not be admitted to any functions

First

Last

E-mail Address

City

State or Province

Country

 

Telephone

      By checking this box, I agree to abide by all requirements The Corneal Dystrophy Foundation sets on providing this service to me.

If I do not agree to the above, I will not Submit my request.

 

Copyright 2011 - The Corneal Dystrophy Foundation  All rights reserved.  No part of this website may, for commercial, profit-making or other non-personal purposes, be reproduced in any form, or stored in a database or retrieval system, or transmitted or distributed in any form by any means, electronic, mechanical photocopying, recording or otherwise without prior written or electronic permission of the Author,  Submit all inquiries to said person via email to the foundation’s Executive Director