The Indiana Attorney General's Prescription Drug Abuse Task Force is always interested in hearing the stories of those who have been impacted by the effects of prescription drug abuse and misuse. You may make a difference in a fellow Hoosier’s life by sharing your story and experience. Please consider submitting your story. Every story matters.
To help warn Hoosiers of the dangers of prescription drug abuse, the task force will be launching a statewide media awareness campaign. This will include multiple types of media including television, radio, Internet, billboards, flyers, educational presentations, handout material, etc.
The individuals showcased within these various mediums will be volunteer voices within Indiana, like you, who have been assembled to tell the story of the negative impact that prescription drug misuse and abuse can create for individuals and loved ones.
UPON CONSENT issued for the various media, these true stories will be collected and utilized/reformatted for medium appropriateness. The goal is to create a diverse tapestry of the faces in Indiana affected by prescription drug abuse with the intent to minimize its impact for all Hoosiers and their loved ones. Thank you for considering volunteering to share your story and consent to use it publicly in a way that honors its intent.
I hereby release my image, likeness and the sound of my voice, and/or words, as recorded for use in a video documentary. I agree that the footage may be edited and used, in whole or in part, in all media, including, but not limited to, audio and production video cassettes, CD‐ROM, DVD, Internet, radio, television, satellite and cable broadcast, print, and for all other related purposes in perpetuity throughout the state of Indiana.
I consent to the use of my name, likeness, voice and basic biographical information in connection with the distribution and promotion of the attached “Prescription Drug Abuse Awareness Campaign”. I understand this is a volunteer basis and I will not receive payment of any kind for the sharing of this information.
I expressly release THE STATE OF INDIANA / OFFICE OF INDIANA ATTORNEY GENERAL/ AND THEIR AFFILIATED ASSOCIATES, from any defamation and other claims I may have arising out of the above‐described materials and hereby waive all rights to inspect and approve the finished product or its use.
Please check this box if you agree to the above information.