Marketing Stories Questionnaire

This form allows the Marketing team to submit pictures from Marketing events.

Submittor Details
Submittor Name*
Enter your name.
Submittor Email*

Please enter your Alaris email so that we may contact you regarding this submission if need be.
Marketing Story Details
Facility*

Please select facility the event was held at.
Name of Event*
Title of the event.
Date of Event*
Event Start Time

: HH

MM
Event End Time

: HH

MM
Attendees

Please list who attended this event.
Keynote Speaker/Partner (if any)
Please list if there are any Keynote Speakers/Partners for this event.
Event Description*

Please provide a brief narrative of why we are hosting the event/taking the picture(s).
Is there a patient in any of the pictures?*
- Yes
- No
Please provide the following: (1) Patient's name(s). (2) Confirmation with your initials that you have a signed photo release for each resident listed above (and in pictures).*
Upload Image(s)
Drop files here or
Upload images or videos to be placed in a gallery of past events on website.
Name
This field is for validation purposes and should be left unchanged.

Submittor Details