My Vincentian Story 

Name *
Name
Phone
Phone
We may need to reach you for follow-up questions or clarification about your story. We will not share your number.
This will help us categorize your story by geography.
Reviewing the CMS Case file may help us fill in any blanks in the story.
This will help us categorize your story by subject.
If names were used in your story, have you already changed them for confidentiality? *
Brief Summary
Full Story- Tell us anything and everything you want to share about your neighbor in need.
Story Release Form *
By submitting this information, I authorize St. Vincent de Paul Georgia, Inc. (SVdP) to use my personal information on this form and subsequent email and verbal conversations including but not limited to: (1) My name, (2) my picture – including photographic, picture, and electronic images, and (3) my story – including any personal information enclosed in the story. By submitting the above information, I agree that I am solely responsible and liable for the personal content I share about others besides myself that may appear in association of the story. By submitting the above information, you agree that the information provided is accurate and truthful. I hereby grant to St. Vincent de Paul Georgia, Inc., its officers, directors, employees, agents, subsidiaries, licensees, successors and assigns, the right to use, publish, and reproduce, for all purposes, my name, pictures, and stories provided by me in electronic and printed form described in sections above and all subsequent communications, verbal and electronic in any and all media including, without limitation, internet, exhibition, distribution, promotion, advertising, press conferences, meetings, hearings, educational conferences, and in brochures and other print media. This permission extends to all languages, media, formats and markets now known or hereafter devised. I further grant St. Vincent de Paul Georgia, Inc. (SVdP) all rights, title, and interest that I may have in all finished pictures, reproductions, and further grant St. Vincent de Paul Georgia, Inc. (SVdP) the right to give, transfer, and exhibit the print in copies or facsimiles thereof, for marketing, communications, or advertising purposes, as it deems fit. I hereby waive the right to receive any payment or compensation for agreeing to this release and waive the right to receive payment or compensation for St. Vincent de Paul Georgia’s use of any material described above for any of the purposes authorized by this release. I also waive any right to inspect or approve finished photographs, multimedia, or advertising copy or printed matter or computer generated scanned image and other electronic media that may be used in conjunction therewith or to approve the eventual use that it might be applied. By submitting the form information to St. Vincent de Paul Georgia, Inc. (SVdP). I acknowledge that I have read the foregoing and I fully understand the contents. This permission shall continue forever unless I revoke such permission in writing to St. Vincent de Paul Georgia, Inc. (SVdP).

If you have an image you would like to include with your story, please email it to stories@svdpgeorgia.org.