Testimony Form - Every Brain Matters

Please fill out this form to submit your testimony to EBM. Your testimony is important and will help bring awareness to the public on the harms of marijuana. A member of our staff will review your testimony and may suggest edits for grammar or clarity. You may remain anonymous if you choose, and rest assured, we will seek your final approval even after submitting this form. For tips and techniques, please visit the EBM website under Learn How to Share Your Testimony drop-down under the Testimony menu or email us at [email protected] with any questions or concerns. Thank you

Name*
First Last
Date
MM slash DD slash YYYY
Email*
Your Testimony
Please speak from your heart. Here is an outline to help guide your testimony. Answer the following questions with just a few sentences. This outline is not a requirement just a recommendation. Intro: Who I am. Describe what your life was like prior to marijuana use. Describe how your life was or is like with marijuana use and what happened. What your life is like now… What do you want the public to know…
publish name or remain anonymous*
Reason to remain anonymous: -We recommend if you are submitting a testimony about your loved one, especially about your son or daughter, that is still living, it’s best to remain anonymous to prevent any problems.
Please include at least 1 to 4 pictures and/or a video
Drop files here or

Max. file size: 3 MB.
If you are choosing to remain anonymous please submit a picture that will hide the identity of your loved one or yourself. If you need us to blur faces or help with editing, please let us know. Thank you for sharing your voice.
Consent*
I consent that my information, pictures, and/or video provided in this form may be use with the Every Brain Matters Organization
Consent
I consent that if my testimony involves psychosis and/or suicide that my story be published on Moms Strong, momsstorng.org. too, as well as Every Brain Matters.
Consent
If my testimony involves marijuana-impaired driving, I consent that this information be used on the Jennifer’s Messengers website and media too. (Jennifer’s Messengers and Every Brain Matters is a project of Parents Opposed to Pot)