* 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.)