* 1. Contest Entry Form

* 2. Gender

* 3. Facebook Site (optional)

* 4. Twitter Username (optional)

* 5. Accessibility needs? I travel with a:

* 6. What heart condition(s) do you have?

* 7. Tell us your CardioSmart story (1,000 words max.) We want to hear how you have tackled heart disease and now live life to the fullest while managing a heart condition.

For inspiration, watch and read our Patient Stories to learn about other patients' struggles and accomplishments on the road to a healthier heart: https://www.cardiosmart.org/Connect/Patient-Stories

* 8. How do you work with your doctors and care team to stay on top of your heart condition? (100 words max.)

* 9. What lifestyle changes did you make to improve your heart health? (100 words max.)

* 10. What challenges do you face? How have you overcome them? (100 words max.)

* 11. Who is your support system? (100 words max.)

* 12. Do you have a personal motto? What inspires you? (100 words max.)

* 13. To complete your entry, please send your full name and a recent photograph of yourself to cardiosmart@acc.org with the subject line: I am CardioSmart.

If you are selected as a winner, this photo and a blurb from your success story will appear as a post on the CardioSmart Facebook page in order to select the grand-prize recipient. (You are not required to have a Facebook account.)