Open Book Storyteller Signup Form

Open Book Submission Form

Thank you for your interest in participating in our Open Book project. Please complete the following form with your contact information and details about your story. Any piece of your story shared publicly by CultureALL for promotional purposes will be shared anonymously.

Name

Mobile Phone Number *

Email address *

Street Address *

City *

State*

How do you prefer to be contacted? *E-MailPhone CallText

Possible Book Titles *

Consider the “labels” people use to describe you; let your title be provocative, intriguing, compelling, etc.

Write a short introduction paragraph about yourself. *

This description could be used to introduce you or attributed anonymously in any promotional material for the Open Book project.

Examples of stories you will share. *

Describe a couple stories you will share; conflicts, times you have faced discrimination, assumptions people have made about you based on your “titles”

Check all the areas you are comfortable participating in. *individual presentation to a large groupindividual presentation to a small grouppanel discussionone-on-one conversation

What languages do you speak fluently? *

Comments, questions, accommodations needed?

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Open Book Submission Form

Visit our Social