Share Your Story

* Your Name:

* Your Email:

* Recipient's Name:

* Recipient's Interests:

(What would you like the community to know about the Recipient? What are some of their interests such as favorite color, subjects, movies?)

* What is your relation to the Recipient?

(i.e. Self, Parent, Aunt, etc.)

Please provide a picture and brief description of the Recipient's situation (required):

* Upload Picture:

* Story Details (include links such as Facebook page, website etc. if applicable):

Optional - Fundraiser Link (will be shared on Love Transfusion's Blog only):

Comments:

Please read the following carefully:

• By submitting this information, I authorize Love Transfusion, Inc. to display the information publically on the following:

Love Transfusion's Facebook Page and Twitter page
LoveTransfusion.com Blog
Love Transfusion's Pinterest page
Love Transfusion's Instagram page

• I am over the age of 17.

• If the information being submitted is for another person, I am authorized to do so on their behalf. I understand that Love Transfusion may make slight editorial modifications to the wording provided.

• I certify that the information above is true and accurate to the best of my knowledge and understand my computer's IP address has been logged.

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