Star Legacy Foundation Star Legacy Foundation - Dedicated to stillbirth research, education & prevention

Interview Appointment Scheduling - Don't Talk About The Baby
Please use this form to sign up to tell your story to the producers of "Don't Talk About the Baby" - a documentary about pregnancy & infant loss. We welcome all stories regardless of the type of loss. Interviews are limited to parents only. Please indicate your 1st, 2nd and 3rd choices. You will be notified of the final schedule soon along with other details. Thank you for shattering the silence and telling your story!
First Name *
Last Name *
Street *
Street2
City *
State *
Zip
Phone (please provide phone we can use to reach you the day of your interview) *
Email *
Baby Name (if you have lost more than one baby please provide additional detail in comments below) If baby was unnamed simply indicate "unnamed" *
Birth/Delivery Date *	// (MM/dd/yyyy)
Loss Type *
Delivery Hospital name and location (city/state) *
Please briefly provide any additional details important to your story. *
Please provide name(s) of those who participate in the interview and relationship to baby *
Are you registered to participate in the Run/Walk event? *
All taping will be done on Saturday, Sept 26th and Sunday, Sept 27th. The location will be provided once the schedule has been announced. Registrants in the run/walk event will be given first priority. Also, priority for time spots will be according to sign up order.
1st Choice *
2nd Choice
3rd Choice
4th Choice
Comments? Questions?

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