MABC Story Bank Collection
Practitioner should fill out this form with the client whose story you are sharing.
Practitioner Email *
Your answer
Practitioner First Name *
Your answer
Practitioner Last Name *
Your answer
Practitioner's organization *
Your answer
Practitioner Phone Number *
Your answer
Clients' first name:
Your answer
Client's last name
Your answer
Client Phone Number
Your answer
Client Home Address
Your answer
Can MABC contact the client for more information?
We may have opportunities for his/her story to be shared in person!
Do you have a photo you are willing to share? *
Please email attachment to mn.assetbuilding@gmail.com, with client name in header
By checking this box, I authorize MABC and its partners to use my photograph, interview, and/or story to promote the activites of MABC and its partners and to make it available to the general public via the Internet, television, written materials or other medium. *
Tell us your story!
Your answer
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