NODCC Communication Request Form

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The NODCC is accepting publication requests for its monthly newsletters. You are welcome to
submit original works of art, poems, stories, news, announcements, etc.

Please know that while we will try to honor your requested month, we cannot guarantee all
requests. Requests must be made at least one month in advance. Your contact information below
will allow someone from the NODCC to contact you with questions and to confirm the month of
publication.

In this form, the word “Story” includes the story, poem or drawing that you’ve written or made, and also includes your name and any other personal information that you send with it. When you send us your Story, you agree that your Story may be used, published and distributed by the NODCC, any organizations related to the NODCC and third parties to whom we give the same rights, worldwide on all media and platforms at any time. You also agree that we may use any personal contact information you provide to contact you about your Story and that we will also use such personal contact information in accordance with our privacy policy located at NODCC.com/privacy. The NODCC alone will decide whether or not to use, publish or distribute your Story and may do so for any reason. However, the NODCC will have no ownership or other intellectual property rights in your Story.

YYYY

Please type your full name below to acknowledge receipt of this disclosure and acceptance of the terms.

Current Residing State

Please indicate how you would like your personal information represented in the newsletter.

First and Last Name

First Name Only

Last Name Only

City Only (no names published)

Anonymous (do not include any part of my name or the city where I live)

Clear selection

Email (This information is only to be used for someone to contact you for questions or clarifying purposes. Your personal contact information will not be published or shared with any outside parties.)

Relationship with the NODCC

Publication Request Description

Do you grant permission to the NODCC to publish this personal work in the NODCC's public newsletter and/or publications? If yes, you will be contacted via email if additional information is needed.

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