The PCDH19 Alliance is a registered non-profit by the Internal Revenue Service under Section 501 (c)(3). We are 100% volunteer run. All the funds we raise go directly to funding research, supporting families, raising awareness, and finding a cure.

Copyright 2019 PCDH19 Alliance

926 A #212 Diablo Ave, Novato, CA 94947

EIN: 45-4020102

July 15, 2019

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To help spread awareness of PCDH19 Epilepsy it is important for the Alliance to share the patient story through a variety of methods. This includes bringing a face to the disease through photos and videos on our website, social media, brochures and other promotional materials. If you are interested in sharing your child’s photo(s), video(s), and/or story with us, please complete the form below.

Any questions on photo and video usage may be directed to Julie@pcdh19info.org.

You can see examples of PCDH19 Epilepsy stories on our website here.

Photo / Media Release

To submit photos or video clips for use on our website, brochures, social media, and/or other promotional materials, please complete the submission form below and upload your hi-res photo files (in jpg or png format) or video clips (not to exceed 2MB).

Submission Form

Photos & Video Clips

Please upload photos in jpg or png format. Video clips should not exceed 2MB. Please try to include your child's last name as part of the file name (i.e., smith_photo_1.jpeg)

Select image
Max File Size 2MB

Tell us about yourself and the person with PCDH19 Epilepsy in your life.

Examples: tell us about your family, where you live, what you like to do, what brings you joy, etc.

When did the person's seizures begin?

What were the early days of the disease like for the patient and family? What led to a diagnosis?

What is your hope for the future of your loved one? For the PCDH19 Epilepsy community?

What advice do you have for newly diagnosed PCDH19 Epilepsy families?

What does the PCDH19 Alliance mean to you?

Signature*

I hereby grant permission to PCDH19 Alliance and its agents or employees to use my child’s photo(s) and/or video(s) which I have submitted for publication in brochures, newsletters, display boards, social media accounts, and websites without notifying me. I also acknowledge that the PCDH19 Alliance may choose not to use my photo(s) at this time, but may do so at its own discretion at a later date. I understand that once my image is posted on the PCDH19 Alliance website, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless PCDH19 Alliance, its agents, volunteers, and employees from any claims. I agree to waive and release any and all claims against the PCDH19 Alliance and its contractors and licensees relating to my name, my likeness, the photo(s) and their uses and/or distribution in any version or media throughout the universe, including without limitation, any rights and claims relating to royalties or compensation, editing, alteration, copyright, distribution, misappropriation, libel, false light, rights of privacy and/or publicity. The PCDH19 Alliance reserves the right to discontinue use of photos without notice. To request that your child’s photo(s) be removed from the website and/or other materials, please submit a written request by email to julie@pcdh19info.org. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.