#IGotTheShot

Question Title

* 1. Please provide your contact information.

Full Name

Practice/Institution Name

Your Instagram Handle (if you want to be tagged in any posts including your photo/video)

Your Facebook Handle (if you want to be tagged in any posts including your photo/video)

Your Twitter Handle (if you want to be tagged in any posts including your photo/video)

Your Practice/Institution's Instagram Handle

Your Practice/Institution's Facebook Handle

Your Practice/Institution's Twitter Handle

Your Email Address

Question Title

* 2. Upload your photo in JPG, PNG, or GIF format here.

PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 3. Upload your photo in JPG, PNG, or GIF format here.

PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 4. Upload your photo in JPG, PNG, or GIF format here.

PNG, JPG, JPEG, GIF file types only.

Choose File

Have more photos to share? Submit multiple responses to the survey or email Alicia Adams at aadams@fcaap.org and Melanie Range at mrange@fcaap.org. Have a video to share? Email Alicia and Melanie!

By submitting photos and videos to FCAAP you confirm that you are the owner of the photos and that you have the permission of everyone in the photos to share the photos with FCAAP, and you acknowledge that photos and videos submitted to FCAAP may be used in a collage or video compilation which may be shared on FCAAP's website, social media pages, and internal publications.