Share Your Story

Share your story with us!

Your story can make a difference for many people in your community who may need health coverage.

Now that you've enrolled in health coverage through Maryland Health Connection, share your story with us by filling out the form below.

Name*
Age (select one)*
City of Residence in Maryland*
County of Residence in Maryland*
Email*
Phone*
Maryland Health Connection helps me because:*
Terms of Service:
By clicking Done below, you:
- Agree that you are 18 years or older.
- Confirm that the name, age, address and other identifying characteristics submitted in this form are your name, age, address and other identifying characteristics, that all the facts submitted in this form are true, that the photo/video you submitted, if any, is a representative photo/video of you, and that you composed your submission yourself.
- Give the Maryland Health Benefit Exchange (Maryland Health Connection) and its assigns, the right to use your name, picture, portrait, audio, video or photograph in all forms of media and in all manners, with the right to alter your image for advertising, trade, promotion, or other lawful purposes. You waive any rights to inspect or approve final or finished versions, including written copy that may accompany your name or image.
- Confirm that you have the right to give Maryland Health Connection permission to use the photo/video you have submitted.
- Agree that, if we decide to share your story, your statements will appear along with your first name, the first letter of your last name, and your city. If we want to share additional information, we will contact you.
- Give Maryland Health Connection permission to contact you for more information if we have any questions about your submission or this authorization.
- Agree that you may receive periodic e-mail updates from Maryland Health Connection. You can unsubscribe at any time.
- Agree that your story — including your name if you provide it — may appear in public advocacy projects. Even if you do not provide your name or photo, keep in mind that some information can reveal who you are, such as unusual details about you or others.
- You have read this release, and you fully understand its meaning.

Share Your Story

Share Your Story

Share Your Story

Share Your Story

Terms of Service:

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