#WhatIWishYouKnewAboutPC

1. Contact Information

First Name

Last Name

State or Country

Email Address

Phone Number

Video URL, if self-posted

2. Upload Your Video (If you have an issue uploading, please upload at https://bit.ly/3qeTHOM )

File: {{filename}} delete

3. Optional: Answer the questions in writing (for those not wanting to do a video)

What do you wish people knew about PC?

Why would that understanding make things better for you or someone you know with PC?

4. Photo & Video Consent Form
- I hereby give my consent to have photographs and/or video taken of myself (or/and my child/children) which will be used by PC Project or PC Project Europe for educational, promotional and research purposes.
- I understand that these photograph(s) and/or video may appear in the public media, including print, internet and/or broadcast media for an indefinite period of time.
- I have been informed that these photograph(s) and/or video may be used more than once for educational and promotional purposes by PC Project.
- I understand my name and personal identifying information will not be associated with the photograph(s) and/or video without my additional written consent.
- I understand I have the right to withdraw the photograph(s) and/or video by a written request to PC Project. *This question is required.

Participant(s) Name(s) [Please list all attendees]
Signature (or guardian's signature for child) by typing the name
Date