Share Your Story | Vitalant

How has your life been enriched by blood donation? Have you or someone you love needed a blood transfusion? Blood recipients, donors, blood drive coordinators, volunteers and those close to them each have unique stories. We’d love to hear yours so that we may share it to inspire others.

If you wish to submit a question or comment on a specific topic, please visit our Contact Us page.

Thank you for being part of something bigger than yourself. You can share your story via the form below.

Your Information

First Name*

Last Name*

Email*

Phone*

Address*

City*

State*

Zip*

Please check all that best describe you.

Blood Donor

Blood Recipient

Blood Drive Coordinator

Parent/Guardian of a Minor Donor/Recipient

Name of minor

DOB of minor

Family Member of

Relationship to and Name of Decedent:

Other

Please describe:

Please share your story in 4000 words or less.

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Attach up to 5 photos or additional information related to your story. Accepted file types: JPG, PNG and PDF. File size is limited to 50MB per file.

Authorization and Release

Authorization and Release for Use of Information, Photographs, Videos and Voice

I hereby authorize Vitalant and/or its affiliates or subsidiaries (collectively referred to herein as “Vitalant”) to use my name (or that of my minor child or ward, or deceased family member) as well as information I provide, photographs, videos, and voice (the “Material”) in any and all publications, broadcasts, electronic communications, news publications, and social media channels for the purpose of creating and disseminating educational, informational, promotional, advertising, or marketing materials to the public, or for any other lawful purpose related to the nonprofit charitable mission of Vitalant.

I understand and agree that this authorization is provided willingly and with no expectation or promise of payment, compensation, or remuneration of any kind from Vitalant. I also understand and agree that the Material shall be the exclusive property of Vitalant. I further understand and agree that the Material will not be submitted to me for my review or approval prior to use and dissemination by Vitalant. By submitting this Release, I, and on behalf of my heirs, executors, administrators, assigns, and personal representatives, hereby release, waive and discharge Vitalant, its directors, officers, employees, and agents from any and all claims or liability arising out of or related to Vitalant’s use and/or dissemination of the Material. Specifically, I understand and agree that Vitalant assumes no liability and will provide no compensation for claims or damages of any kind whatsoever resulting from Vitalant’s use and/or dissemination of the Material, including but not limited to claims for misappropriation, libel, slander, invasion of privacy, or lack of consent.

I understand that I may revoke this authorization at any time by sending a written request to Vitalant c/o Privacy Officer, Vitalant National Office, 9305 E. Via De Ventura, Scottsdale, AZ 85258 or by email to: PrivacyOfficer@vitalant.org. I understand and agree that any previously disseminated Material will not be subject to such revocation.

By checking this box and clicking “Submit” below, I am attesting that the information I have provided above is true and correct, that I have read and understood the Authorization and Release above, and I am 18 or older. *