Seen & Heard Questionnaire
Thank you so much for your interest in playing a part in The Seen & Heard Project. To get started, please fill out the questionnaire below. Each storyteller will be contacted for additional information and so that her story can be shared in the project's format.

I look forward to seeing and hearing you.

Warmly,

Wokie
The Seen and Heard Project

Name *
Your answer
Email *
Your answer
Phone Number
Your answer
Age
Your answer
Website (if any) *
Your answer
Where do you live? (Please add your state and country)
Your answer
Tell me a little bit about yourself. *
Your answer
Tell me a brief story about an experience (or pattern of experiences/messages) that has had the greatest impact on your feelings about being seen & heard. This experience can be from any time in your life. If you have more than one story, please let me know. *
Your answer
What impact has this experience had on your life?
Your answer
What is the most important lesson you story can teach?
Your answer
How do you want to use your voice in the world right now?
Your answer
How would you prefer that we capture your story? (Please not that interview slots are not available at this time.) *
Will you allow you first name to be used on The Seen and Heard Project website? *
Will you allow your image to be displayed on The Seen and Heard Project website? *
By checking below, I agree to the terms described herein and allow The Seen and Heard Project to share your story and image (if submitted) online. *
General Terms
By signing below, you are agreeing to the following terms:

I warrant that the story and photo(s) submitted are my own original work and are not copyrighted by an entity; that neither infringes upon the rights of others;
 and that neither contains information which may cause harm or injury.

I understand and agree that my story, as submitted or written by Wokie Nwabueze or Wokie Nwabueze, LLC, as well as my name, likeness, voice and biographical material ("the materials"), may be used for commercial, educational or informational purposes.

I agree to hold harmless the publisher Wokie Nwabueze and Wokie Nwabueze, LLC and all its agents from any and all claims, damages and expenses and legal fees which may arise out of the use of the materials and will allow Wokie Nwabueze and Wokie Nwabueze, LLC to publish my story as a part of blog, The Seen & Heard Project or any other publication for an unrestricted amount of time.

I agree to defend, indemnify, and hold harmless Wokie Nwabueze and Wokie Nwabueze, LLC and all its agents, from all liabilities and expenses whatsoever which may incur arising out of my submission or the publication of my story and/or any negligence or willful misconduct by Wokie Nwabueze and Wokie Nwabueze, LLC.

If this story has been previously published elsewhere, I agree that I am authorized to submit this story to Wokie Nwabueze, Wokie Nwabueze, LLC and SeenAndHeard.com and I agree that this submission does not violate the previously binding terms of that prior publication.

I waive any rights of copyright or ownership in the resulting commercial, educational and informational materials in which I appear, and acknowledge that no monetary or other compensation is provided in exchange for waiving this right.

I represent that I have the right, capacity, and authority to enter into this agreement (“the Agreement”) and that my participation and performance and the rights I have granted in the Agreement will not conflict with or violate any commitment or understanding I have with any other person or entity.

I hereby certify that I have read and ACCEPT the foregoing and fully understand the meaning and effect thereof, and intending to be legally bound, hereunto set my signature this:

How did you hear about The Seen and Heard Project? *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Women Prepared to Lead. Report Abuse - Terms of Service - Additional Terms