Please tell us the circumstances related to the adoption.  (Including, but not limited to when it happened, why the child was given up for adoption, etc.)
How has your life changed since the adoption?
Has there been a reunion between the child and parent(s)?  If so, how has your life changed since the reunion?
What is unique and or inspirational about your story?
Referral Source (person, adoption agency, web site, etc.)?  How did you hear about this project? (e.g. The Cradle)
* First Name
* Last Name
Your Web Site URL (e.g. www.YourWebSite.com)
* E-mail
* Confirm E-mail
* Address
* City
* State/Province
* Zip/Postal Code
* Country
* (Country/Area Code) Phone Number
* In addition to using your story in our book and e-book, may we also post it on our web site?	Yes - Including My Name Yes - But Without My Name No - Just use it in the book and e-book
* You may contact me about my contribution.	Yes - I know that this will help greatly with the book No - Your may freely use my contribution, but do not make contact
Terms for Submission   You are being asked to contribute your recollections to a book and/or e-book that is planned to be published by Alpha Multimedia, Inc.  Your participation in this project will allow adoptees, or families with adopted children, to gain a greater understanding of these issues and the responses to them.   The current title of The Joy of Search: Stories of Adoption, Reunion and Inspiration by Thomas Brooks is subject to change. You must be 13 years of age or older to submit material to us. Your submission of material constitutes your permission for, and consent to, its dissemination and use in all media in perpetuity. If you have so indicated on the form, your material may be published on the Alpha Multimedia website and related websites (with or without your name, depending on what you have indicated).  The material you submit must have been created by you, wholly original, and shall not be copied from or based, in whole or in part, upon any other photographic, literary, or other material, except to the extent that such material is in the public domain. For this project, Thomas Brooks and Alpha Multimedia, Inc. may work with other local and national institutions and publishing companies.  By submitting material to this us, you also permit us to use the material for publication, exhibition, archival, educational, promotional and other purposes in any and all media. By submitting material to us, you release, discharge, and agree to hold harmless Alpha Multimedia and persons acting under its permission or authority from any claims or liability arising out of the Alpha Multimedia use of the material, including, without limitation, claims for violation of privacy, defamation, or misrepresentation. Thomas Brooks and Alpha Multimedia, Inc. have no obligation to use your material. We cannot return any material you submit to us so be sure to keep a copy.  Alpha Multimedia will not share your E-mail address with commercial vendors. If you are unclear about any aspect of this consent form, you may contact us for clarification.   Alpha Multimedia, Inc.                       Phone:  +1 (281) 217-1960 P.O. Box 722034 Houston, TX 77272-2034   By submitting your story, you agree to the terms outlined on this page.

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