Submit a HOOT for Healthcare HeroesName of Individual Submitting Story:* First Last Is it ok that we include your name?* Yes NoEmail:* * You may be contacted by our community education department via email to complete an authorization form and release for your story to be used on our website and social media pages. Your email will not be used for other purposes beyond contacting you for this story unless you opt-in to our newsletters.Opt-In Opt-in to Quarterly Wings Newsletter Opt-in to Annual Email UpdateSubmit your Positive or Supportive HOOT Here:*Would you like to submit a photo?* Yes NoSubmit a photo to upload:Photo & Name Authorization* By checking the box, you authorize and release these names, the story and the submitted photo to be used. Proceed to date and signature portion.Date* Date Format: DD dash MM dash YYYY Signature*Left-click and hold down on your mouse to sign.