Share Your Story Form

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Thank you for sharing your story with Planned Parenthood of Western Pennsylvania. Your voice can make a difference!

PREFERRED NAME: *

PRONOUNS

FIRST NAME: *

LAST NAME: *

I STAND WITH PLANNED PARENTHOOD BECAUSE: *

I (CHECK ALL THAT APPLY):

Am a current Planned Parenthood patient

Am a former Planned Parenthood patient

Am a health care provider

Am a student

Am a parent

Am a supporter

EMAIL ADDRESS *

CITY

STATE *

ZIP *

MOBILE: *

DATE OF BIRTH *

YYYY

WHICH RACIAL OR ETHNIC GROUP(S) DO YOU MOST IDENTIFY WITH?

African American and/or Black

Asian American and/or Pacific Islander

Hispanic and/or Latinx

Native American and/or Native Alaskan

Arab American and/or Middle Eastern

White (non-Hispanic)

Choose not to disclose

Other:

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By clicking the "Share my Story" button, you agree to the terms below:

Share my Story

By clicking the "Share my Story" button, you agree:

You are 18 years of age or older.

You confirm that you have written your submission yourself. If your story includes details about anyone else, you confirm that you have permission to share such details.

You give Planned Parenthood of Western Pennsylvania, Planned Parenthood Federation of America (PPFA) and any other Planned Parenthood entity (collectively, "Planned Parenthood") permission to use your submission or any portion of it in current or future promotional materials and in fundraising, advocacy, or media outreach projects and materials, including sharing your words publicly with a variety of audiences, media, or publications, including the press, and in multiple media formats.

Your submission may be used alone or together with other materials, and Planned Parenthood may shorten or use only part of your submission. Planned Parenthood may also decide not to use your submission.
If we decide to share your story, your statements will appear along with your first name, last name, age, city, and state.

We may share your submission, in whole or in part, without contacting you further; however, Planned Parenthood may also contact you for further details or further authorization or with questions about your submission.

You waive any rights and compensation arising from such use, and release Planned Parenthood from any claims arising from such use.

In sharing your story, please keep in mind that your story — including your name if you provide it — may appear in public advocacy projects. Even if you do not provide your name, keep in mind that some information can reveal who you are, such as unusual details about you or others.

You will receive periodic e-mail updates from Planned Parenthood. You can unsubscribe at any time.

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