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Chisme Submission Form
A questionnaire designed to help us get to know you and your story.
Un cuestonario diseñado para ayudarnos a conocerte a ti y a tu cuento.
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* Indicates required question
Email
*
Your email
Your name / Tu nombre
*
Your answer
Preferred language / Lenguaje preferido
*
English
Español
Best way to contact you / Mejor manera de contactarte
*
phone / telefono
Email
Other:
Required
Phone Number / Numero Telefonico
*
Your answer
Email
*
Your answer
Do you want to be anonymous? / Quieres ser anónima?
*
Yes / Si
No
Brief Summary of your story / Resumen del chisme
*
Your answer
By submitting this form I am granting permission to use my story on Suelta La Lengua con Itati and any materials pertaining to the show.
Al someter estos materiales estoy confirmando dando permiso de usar mi historia en Suelta La Lengua con Itati y materiales del show.
*
I agree / Estoy de acuerdo
I disagree / NO estoy de acuerdo
Send me a copy of my responses.
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