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Social Media Picture
and Testimonial
Submission Form

This form is for submitting Pictures and/or Testimonials to us, for use on our
Social Media Channels (FaceBook, Twitter, Instagram, etc.).

- EXAMPLES -
You can choose to submit a Picture, Testimonial, or both, see below for examples of how they will be used:

Picture AND Testimonial
submitted

Picture Testimonial submission

Picture ONLY
submitted

Picture submission

Testimonial ONLY
submitted

Testimonial submission

Submission Form

(*) = Required
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Attach up to 5 pictures (optional)

Picture did not uplaod: Try a smaller sized picture
Picture did not uplaod: Try a smaller sized picture
Picture did not uplaod: Try a smaller sized picture
Picture did not uplaod: Try a smaller sized picture
Picture did not uplaod: Try a smaller sized picture
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Usage of Picture Permission: By submitting this form and picture, I/we give permission for Autism on the Seas to reproduce through the following, the image of the individuals listed above, in the picture attached to the submission of this form: In the Autism on the Seas television, radio, webinar, website, Facebook page, or any internet related medium. I/we understand that complete confidentiality of all audiovisual materials will be maintained and that these materials will only be used for the purposes indicated above.

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