WE MOVE - Tell Us Your Story

A⁺ a^-

Tell Us Your Story

All of the stories featured on the WE MOVE Web site were submitted by our public visitors. If you would like to share your personal experience with the movement disorder community, please complete the form below. Your story may be featured on the WE MOVE Web site. Please read the important Terms of Use information before submitting your story.

First Name:

Last Name:

Your E-mail and postal addresses are collected but will NOT be displayed.

E-mail Address:

Postal Address:

City:

State or Province:

Country:

Zip/Postal Code:

Terms of Use

Thank you for your interest in participating in WE MOVE Patient Stories on www.wemove.org.  The purpose of the WE MOVE Patient Stories section is to provide a forum for individuals impacted by a movement disorder to share their individual experiences with others in the WE MOVE community who might benefit from knowing that they are not alone.  By submitting a story and photo, you acknowledge that:

•  a submission does not guarantee utilization of your story 
•  if your story is accepted, it will be posted on www.wemove.org 
•  your story is subject to editing
•  the story and photograph becomes property of WE MOVE
•  you will receive no renumeration for utilization and posting of your story and photograph

By submitting a story and photo, you give WE MOVE and any of its subsidiaries permission to use, publish or copyright the story and photo without restrictions as to changes or alterations, for the purposes of medical education and awareness as related to WE MOVE and any of its subsidiaries.  The permission includes www.wemove.org, other all forms of electronic media and print media.  
You also consent to the use of any printed materials in conjunction therewith.  You waive any right that you may have to inspect or approve the finished, or the educational use to which it may be applied.  By submitting, you understand that this universal release shall be valid for an indefinite period of time, unless it is revoked in writing.  You also understand that you will not be compensated for the use of your photograph or story.

Limitation of Liability

WE MOVE shall not be liable for any indirect, special, incidental, consequential or exemplary damage, including but not limited to personal injury, or wrongful death, whether in any action in warranty, contract, tort or otherwise arising out of or in any way connected with your submission and participation in WE MOVE Patient Stories chat rooms, even if an authorized representative of WE MOVE is advised of the likelihood or possibility of same.

I agree to the Terms of Use stated above

If you were to write a book about your story, what would be the title?

Does your story involve a particular movement disorder?

	Ataxia / Olivopontocerebellar atrophy		Bradykinesia
	Choreoathetosis		Conditions associated with movement disorders
	Corticobasal degeneration		Dyskinesias, paroxysmal
	Dystonia		Essential tremor - See Tremor
	Hemiballismus		Hemifacial spasm
	Hereditary Spastic Paraplegia		Huntington's disease
	Multiple system atrophy		Myoclonus
	Parkinson's disease		Paroxysmal Dyskinesias
	Progressive supranuclear palsy		Restless legs syndrome
	Rett syndrome		Spasticity
	Stiff-person syndrome		Sydenham's chorea
	Tardive dyskinesia / Dystonia		Tics / Tourette's syndrome
	Tremor		Wilson disease

Please tell your story

Please limit your story to 1000 words, roughly two printed pages.

If there is a central message to your story, what is it?

Please summarize to four sentences or less.

Based on your story, what words of encouragement can you offer to others?

Please summarize to four sentences or less.