It may take a few moments for your form to send. Please wait and do not refresh the page. Step 1 Submission Requirements Step 3 Step 4 Content Submitter Please fill in your contact information here. If you are submitting content on behalf of a relative or someone else, you will also fill in their contact information in the next step. You can submit as many items as you wish. Please submit one form for each upload. Name E-mail Phone Number Zip Code Submission Requirements Materials License and Broadcast Release Project Title: A Time to HealPermission and Grant: For valuable consideration received, I hereby grant The Pennsylvania State University on behalf of WPSU (“Penn State”) and its affiliates, trustees, officers, agents and employees an irrevocable, worldwide, royalty-free right and license to use, reproduce, display, archive, distribute, edit, modify, create derivative works and broadcast (via television, radio, print media, internet, webcasts, podcasts, other streaming services, original programming, or through any other communication medium existing or later created) the Work. Furthermore, to the extent applicable I hereby authorize and consent to the use of my name, likeness, and voice in the Work for WPSU’s use. I hereby retain and Penn State hereby grants a non-exclusive license to use the Work for non-commercial purposes. Waiver and Release: I hereby waive all rights and release Penn State, WPSU and all their affiliates, trustees, officers, agents and employees from any claims, damages or liabilities arising from or related to the use of the Work and, to the extent applicable, my image, name, likeliness, performance, biographical information, and/or voice or any moral rights therein. I have no right of approval or inspection and no claim for compensation arising out of or in connection with, any use, reproduction, derivative work, recording, broadcast or distribution of my performance, whether that use is known or unknown to me.Representations: I hereby represent that I am over the age of 18 years old and that I am competent to contract in my own name. I represent that the Work: (a) is my original work, or if it is not that I have obtained all rights necessary for the grant of this license, and (b) to the best of my knowledge does not infringe the rights of any third party. I further represent that I have read this Materials License and Broadcast Release, fully understand its content, meaning and effect and agree to be bound by it.Indemnification: I shall indemnify and hold Penn State and their grantors, officer, trustees, assignees, agents, licensees, and employees harmless from and against all claims, losses, costs, expenses, settlements, demands, and liabilities of every kind, including reasonable attorney fees and expenses, arising out of or incurred by reason of the use of the Work set forth herein or the inaccuracy, alleged breach of any representation, warranty, covenant, agreement, or undertaking I have made herein. Agree to Materials License and Broadcast Release* Please select No Yes Veteran/Civilian Information Which best reflects the category of your submission? Please select one Ceremony Combat Draft MIA/KIA Pop Culture Protests Reunion Vietnamese Were you veteran or civilian during the Vietnam War? Please select one Civilian Veteran Check if Submitter and Veteran/Civilian contact Information are the Same * Name E-mail Phone Number Hometown Military Branch Select Military Branch U.S. Air Force U.S. Army U.S. Coast Guard U.S. Marines U.S. Navy Rank Location during Vietnam War Story Upload Media Feel free to upload any media that goes along with the story. This could be anything from a newspaper article to a song that was written. We encourage you also to upload at least one image so we can provide the story with a profile image. Maximum file size of 20MB. Maximum limit of 5 media uploads per form. Media Type Audio Document Letter Newspaper Photo Video Set as Profile Picture Location Date Description* Upload File Video Url (Vimeo/Youtube link) Media Type Audio Document Letter Newspaper Photo Video Set as Profile Picture Location Date Description* Upload File Video Url (Vimeo/Youtube link) Media Type Audio Document Letter Newspaper Photo Video Set as Profile Picture Location Date Description* Upload File Video Url (Vimeo/Youtube link) Media Type Audio Document Letter Newspaper Photo Video Set as Profile Picture Location Date Description* Upload File Video Url (Vimeo/Youtube link) Media Type Audio Document Letter Newspaper Photo Video Set as Profile Picture Location Date Description* Upload File Video Url (Vimeo/Youtube link) Add Row Submit Leave this field blank Step 1 Content Submitter Please fill in your contact information here. If you are submitting content on behalf of a relative or someone else, you will also fill in their contact information in the next step. You can submit as many items as you wish. Please submit one form for each upload. Name Email Phone Number Zip Code Submission Requirements Materials License and Broadcast Release Project Title: A Time to Heal Permission and Grant: For valuable consideration received, I hereby grant The Pennsylvania State University on behalf of WPSU (“Penn State”) and its affiliates, trustees, officers, agents and employees an irrevocable, worldwide, royalty-free right and license to use, reproduce, display, archive, distribute, edit, modify, create derivative works and broadcast (via television, radio, print media, internet, webcasts, podcasts, other streaming services, original programming, or through any other communication medium existing or later created) the Work. Furthermore, to the extent applicable I hereby authorize and consent to the use of my name, likeness, and voice in the Work for WPSU’s use. I hereby retain and Penn State hereby grants a non-exclusive license to use the Work for non-commercial purposes. Waiver and Release: I hereby waive all rights and release Penn State, WPSU and all their affiliates, trustees, officers, agents and employees from any claims, damages or liabilities arising from or related to the use of the Work and, to the extent applicable, my image, name, likeliness, performance, biographical information, and/or voice or any moral rights therein. I have no right of approval or inspection and no claim for compensation arising out of or in connection with, any use, reproduction, derivative work, recording, broadcast or distribution of my performance, whether that use is known or unknown to me. Representations: I hereby represent that I am over the age of 18 years old and that I am competent to contract in my own name. I represent that the Work: (a) is my original work, or if it is not that I have obtained all rights necessary for the grant of this license, and (b) to the best of my knowledge does not infringe the rights of any third party. I further represent that I have read this Materials License and Broadcast Release, fully understand its content, meaning and effect and agree to be bound by it. Indemnification: I shall indemnify and hold Penn State and their grantors, officer, trustees, assignees, agents, licensees, and employees harmless from and against all claims, losses, costs, expenses, settlements, demands, and liabilities of every kind, including reasonable attorney fees and expenses, arising out of or incurred by reason of the use of the Work set forth herein or the inaccuracy, alleged breach of any representation, warranty, covenant, agreement, or undertaking I have made herein. Agree To Terms Veteran/Civilian Information Which best reflects the category of your submission? CombatCeremonyDraftMIA/KIAPop CultureProtestsReunionVietnamese Were you veteran of civilian during the Vietnam War? Check if Submitter and Veteran/Civilian contact Information are the Same Name E-mail Phone Number Hometown Military Branch U.S. Air ForceU.S. ArmyU.S. Coast GuardU.S. MarinesU.S. Navy Rank Where in Vietnam Your Story Upload Media Maximum limit of 5 media uploads per form. Media Type AudioDocumentLetterNewspaperPhotoVideo Date (When event took place) Location (Geographic) Item Description Upload File: Media Type AudioDocumentLetterNewspaperPhotoVideo Date (when event took place) Location (geographic) Item Description Upload File Media Type AudioDocumentLetterNewspaperPhotoVideo Date (When event took place) Location (geographic) Item Description Upload File Media Type AudioDocumentLetterNewspaperPhotoVideo Date (When event took place) Location (geographic) Item Description Upload File Media Type AudioDocumentLetterNewspaperPhotoVideo Date (When event took place) Location (geographic) Item Description Upload File Submit