Share Your Story

If you are a woman living with HIV/AIDS in the South, we want your voice to be heard. 

If you would like to be a part of the Southern AIDS Living Quilt and share your own story, please fill out the form below, and we will contact you. The Southern AIDS Living Quilt can help you share your story through video, audio over the telephone, or in narrative form with a picture.

Please call us at 800.461.6946 or send an e-mail to info@livingquilt.org with any questions you may have.

First Name:
Last Name (optional):
E-mail Address:
State: Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Disctrict of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massuchusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
                                
Video:         Audio with Picture:        Narrative Form with Picture:

Your Story (Please limit your story to 300 words or less.)

We at the Southern AIDS Living Quilt take your privacy very seriously.
Please read the policy below before submitting your story.

Southern AIDS Living Quilt RELEASE FORM

I irrevocably and absolutely consent to the unrestricted use by the Southern AIDS Living Quilt and its designees, and those acting with the Living Quilt’s permission and authority, of my name, personal information and any or all photographic or video images of me that the Living Quilt creates or makes, for all purposes, in any form, and in any and all media.

I waive any right to inspect or approve the finished images, copy, text, or other printed matter that may be used in conjunction therewith, or to the eventual use that the images may be applied.

I release and discharge the Living Quilt and those acting under the Living Quilt’s authority from any and all liabilities, claims and demands arising out of or relating to any blurring, distortion, or alteration whether intentional or otherwise, that may occur or be produced in connection with the images, or in connection with any processing, alteration, transmission, display, publication or other use of the images.

This agreement constitutes the sole, complete and exclusive agreement between the Living Quilt and me regarding the images and I am not relying on any other representation whether oral or written.