Share Your Story: Nov 23 Video Shoot in L.A.
We’re currently working on a fundraiser video and our founder, Ben Munoz, will be in Los Angeles together with other community members to shoot interviews.

If you would be willing to share your story on camera with our donors, it would mean the world to us!!

Are you available on Saturday, November 23 to meet with founder Ben Munoz and other community members for a video shoot?

Please note that the video shoot will be on the west-side of LA.

If you can join us, please fill out and submit this form.

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Email *
Yes! I can join you in the video shoot to share my story for the fundraiser.
Name: *
Patient Community: *
Screen Name on Your Community *
City where you live:  ** Please note that the video shoot will be on the west-side of L. A. *
I’m available on November 23: *
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